You did put your self at a risk to contract HIV through unprotected penetration with a known positive individual. Though, the exposure was brief. However, it was a risk.
You started PEP late, the recommended time frame is within 72 hours post exposure.
You need to discontinue PEP as it is not effective when started later than 72 hours. Now, it should be your individual choice whether you want to continue your course of PEP for 30 days or not.
You need get a PCR RNA Nucleic acid test at 14 days from the date of exposure. This test is unaffected by PEP and it can look for the viral RNA genome directly in to your body.
If you get infected from this exposure, the above test will help you in managing the virus early and lead to a better life expectancy. Also, with the advancement of drug combinations today and by practcing a healthy lifestyle a better life can be achieved.
You are not supposed to have any unprotected sex with any individual at this point.
The right course of action from here is discontinuation of PEP. Get a PCR RNA, take a 4 generation HIV test at exact 28 days from the date of PEP discontinuation or finishing the last dose of it.
There is a ray of light, it has been observed that the odds of FTM transmission is 1:1000 for a full episode of unprotected penetrative vaginal intercourse.
Also, you were exposed for a breif moment and not the entire time. It is usually observed that a male individual who contracted the virus from a female partner through unprotected vaginal sex had multiple unprotected exposures with the same partner.
Should you need to reach out to me for any further assistance, you could feel free to send me PMs in my inbox. You will be in my thoughts and prayers.
That's unfortunate. Unprotected sex is a risk. However, do keep in mind it is minimal. The percentage of transmission of HIV from a one time, brief vaginal exposure is around less than 2 percent. That means you have a 98 percent chance of NOT getting HIV from this so you probably won't, odds are in your favor. At the 4 day mark you were put on PEP? That's too late, you can only use it if started within 72 hours. Lots of side effects for you with a too late of start so agree that you should talk to the doctor who gave it to you and discontinue it. Then you have to wait a little longer to get your HIV test. Remember the odds, they are LOW, that you will get HIV. But get guidance from a good doctor about the right time to take the test for an accurate result now that you took PEP.
Based on a study conducted in the year 2012 for diagnosis of perinatal HIV-1 infection during anti-retroviral prophylaxis in exposed infants, it was observed that poitive or detectable predictive value at less than or equal to 7 days of age was 100% for HIV RNA PCR and it was 78% for DNA PCR.
HIV retrovirus carries single-stranded RNA as it's genetic material. It has the enzyme reverse transcriptase, which allow it to copy RNA into DNA and use that DNA copy to infect the host and conduct replication process.
When HIV infects a cell, it gets attached to the host cell and then it fuses with it. Then the single stranded viral RNA is converted into complementary DNA (cDNA) and the virus uses the host cell’s machinery to replicate itself during a process called reverse transcription.
Hence, in a scenario less then a month or during ARS, PCR RNA tests is best. It is mostly advisable at 9 - 14 days after the exposure. In your case, 9-14 days post discontinuation of PEP. However, after a month a PCR DNA test would be best. However, at this point a IV Generation HIV test would work just as good or even better.
The HIV Antibody & P24 antigen Combi Test is an excellent, accurate and inexpensive HIV test in comparison to NATs that reliably detects HIV infection that occurred just 28 days prior to the test. This HIV test is known as the 'Duo' because it tests for both HIV antibodies as well as the 'HIV P24 antigen'. The HIV p24 antigen is a core HIV viral protein which becomes detectable at approximately 10 days post exposure, peaks at 16 days or so and then remains at high level for 8 to 10 weeks post exposure. It will then fluctuate over the rest of the course of the illness. HIV p24 antigen is extremely useful in combination with an HIV antibody test in determining early on whether an individiual has been infected with HIV. The HIV DUO test including p24 antigen is rated as 99.8% accurate at the 28th day.
This test result is encouraging. There is a good chance that you didn't acquire the virus.
However, being on PEP can also suppress the viral load as it is nothing but ARV drugs itself. The first course of action to determine if there was infection is done. Now, you need a final one at 28 days post finishing PEP with a Duo test for a conclusive.
Please keep consulting with your infectious disease doctor for the correct course of action.
I recommended you the right course of action:
Below is the assesment:
1. You started PEP late. If there was a scope of contraction and the virus would have been present and replicating, it would have been in huge loads by now, ARV drugs might not have been able to cope up instantaneously as it usually takes gradual decrease. Hence an undetectable PCR RNA would be encouraging.
However, at no point it was told to you that this is conclusive, RNA PCR is not a general diagnostic test, this is used exactly as recommended on you- You have taken this because you had an exposure with a known positive who probably had big viral load. (As stated by yourself, you discovered, she was positive and got it from her husband who died of AIDS). The good news with an 'undetected' RNA NAT is that we didn't defer in early management if there was an infection at the first place. You should look at it from that perspective and not just attaining 'black or white', its not going to happen, your ordeal is real and you have to follow right testing path.
2.The correct course from here is to stay calm with your undetectable result and back that up with a DUO at 4 weeks from the last date of your PEP.
I have only followed the right testing protocol advisable in your situation. However, you should always follow your infectious disease doctor and I have specified that each time here.
I gave you the most practical information which most likely, Dr.HHH who was here, would have given you, on contrary to most experts who would just read out from their HIV text book. I feel you should hangin' there, just take that 4th Gen HIV Ag & Ab. Wishing you good luck.
Fantastic news! Undetectable RNA at 24 days is great news. You most probably haven't acquired the virus.
In my opinion, for confirmatory purposes please take a IV Generation HIV test at 28 days or any standard antibody test at 6 weeks for a conclusive, I promise it will be negative. You should keep consulting with your doctor for correct tests and timelines. You don't seem to have HIV.