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FYI - Tested negative through 6.5 weeks
FYI to all my fellow WWs since I know we all like to get periodic updates from one another:
I went for a 6.5-week post-exposure (2-week post-PEP) HIV test today. It was negative.
I was tested at the Whitman Walker Clinic in DC using the OraQuick Advance HIV-1/2 rapid antibody test by finger stick, not oral swab.
For those in the DC area, WWC has recently discontinued the use of the oral swab test and uses only the finger stick method now.
Although my results are not CONCLUSIVE, they're highly reassuring for me. I still need follow-up testing at 13 and 24 weeks due to PEP. (For those who don't recall, I had a receptive oral exposure to pre-ejaculate from a man who later told me he was HIV+ and had a VL of 20,000. I started PEP at the 25th hour and continued for 28 days).
I went for a 6.5-week post-exposure (2-week post-PEP) HIV test today. It was negative.
I was tested at the Whitman Walker Clinic in DC using the OraQuick Advance HIV-1/2 rapid antibody test by finger stick, not oral swab.
For those in the DC area, WWC has recently discontinued the use of the oral swab test and uses only the finger stick method now.
Although my results are not CONCLUSIVE, they're highly reassuring for me. I still need follow-up testing at 13 and 24 weeks due to PEP. (For those who don't recall, I had a receptive oral exposure to pre-ejaculate from a man who later told me he was HIV+ and had a VL of 20,000. I started PEP at the 25th hour and continued for 28 days).
http://www.medhelp.org/forums/HIVSupport/messages/681.html
Xhost - here's a quick summary from a recent post I had regarding PEP. In addition to these, there are some studies from 9+ years ago that indicate delayed seroconversion although the studies don't mention PEP or HCV coinfection.
There's been some interest and debate here on the effects on PEP on seroconversion in patients who seroconvert, so I did some research. Here's what I've found:
The general consensus is that PEP does not, except in rare circumstances, impact the time to seroconversion.
Links/Excerpts:
http://www.dhs.ca.gov/aids/Resources/pdf/pepguidelinesfinal.pdf
A case of delayed seroconversion in a treated monkey suggests that delayed seroconversion may occur in the context of human PEP, although this has not been reported in either the occupational or non-occupational setting except during co-transmission with hepatitis C [4, 11, 29].
http://www.thebody.com/cdc/pep/pep06.html
Three instances of delayed HIV seroconversion occurring in HCWs have been reported; in these instances, the HCWs tested negative for HIV antibodies >6 months postexposure but were seropositive within 12 months after the exposure. Two of the delayed seroconversions were associated with simultaneous exposure to hepatitis C virus (HCV).
Related:
http://italia.medscape.com/viewarticle/513928
There are currently 6 worldwide case reports of HIV seroconversion despite combination HIV PEP. (2003 study)
http://www.hivinsite.org/InSite?page=pr-rr-07-01-05
[Effectiveness of nPEP]
Since there has not been a CONCLUSIVE study of the effect on PEP of timing to seroconversion, current recommendations are still to test through 6 months. For practical reasons, it is unlikely that any detailed study of timing to seroconversion (with or without PEP) is forthcoming.
1. Prescribing PEP after low risk exposures needs to be considered very carefully due to the risk of liver toxicity, which is potentially more life threatening than HIV. For certain 'borderline' situations, like mine, I think that the decision needs to be made in collaboration between the doctor and patient.
For example, prescribing PEP for oral exposure (low risk) to a person of unknown serostatus (? risk) would be unwarranted.
Prescribing PEP for anal exposure (high risk) to a person of unknown serostatus (? risk) would be recommended.
But prescribing PEP for oral exposure (low risk) to someone of KNOWN HIV+ serostatus (high risk) is a 'borderline' case that I think warrants discussion.
Due to the unknown effects of PEP on seroconversion, I think testing through 6 months is good practice, regardless of exposure type, although 3-month tests are probably VERY reliable.
If I had to do it all over again, I'd definitely go on PEP. I'd never want to wonder 'what if' if I were ultimately infected after having decided against PEP. But PEP was definitely no picnic, so I wouldn't look forward to it!
Xhost - here's a quick summary from a recent post I had regarding PEP. In addition to these, there are some studies from 9+ years ago that indicate delayed seroconversion although the studies don't mention PEP or HCV coinfection.
There's been some interest and debate here on the effects on PEP on seroconversion in patients who seroconvert, so I did some research. Here's what I've found:
The general consensus is that PEP does not, except in rare circumstances, impact the time to seroconversion.
Links/Excerpts:
http://www.dhs.ca.gov/aids/Resources/pdf/pepguidelinesfinal.pdf
A case of delayed seroconversion in a treated monkey suggests that delayed seroconversion may occur in the context of human PEP, although this has not been reported in either the occupational or non-occupational setting except during co-transmission with hepatitis C [4, 11, 29].
http://www.thebody.com/cdc/pep/pep06.html
Three instances of delayed HIV seroconversion occurring in HCWs have been reported; in these instances, the HCWs tested negative for HIV antibodies >6 months postexposure but were seropositive within 12 months after the exposure. Two of the delayed seroconversions were associated with simultaneous exposure to hepatitis C virus (HCV).
Related:
http://italia.medscape.com/viewarticle/513928
There are currently 6 worldwide case reports of HIV seroconversion despite combination HIV PEP. (2003 study)
http://www.hivinsite.org/InSite?page=pr-rr-07-01-05
[Effectiveness of nPEP]
Since there has not been a CONCLUSIVE study of the effect on PEP of timing to seroconversion, current recommendations are still to test through 6 months. For practical reasons, it is unlikely that any detailed study of timing to seroconversion (with or without PEP) is forthcoming.
1. Prescribing PEP after low risk exposures needs to be considered very carefully due to the risk of liver toxicity, which is potentially more life threatening than HIV. For certain 'borderline' situations, like mine, I think that the decision needs to be made in collaboration between the doctor and patient.
For example, prescribing PEP for oral exposure (low risk) to a person of unknown serostatus (? risk) would be unwarranted.
Prescribing PEP for anal exposure (high risk) to a person of unknown serostatus (? risk) would be recommended.
But prescribing PEP for oral exposure (low risk) to someone of KNOWN HIV+ serostatus (high risk) is a 'borderline' case that I think warrants discussion.
Due to the unknown effects of PEP on seroconversion, I think testing through 6 months is good practice, regardless of exposure type, although 3-month tests are probably VERY reliable.
If I had to do it all over again, I'd definitely go on PEP. I'd never want to wonder 'what if' if I were ultimately infected after having decided against PEP. But PEP was definitely no picnic, so I wouldn't look forward to it!
Strata,
Agree with Peakawho - glad to hear your latest test results, and you sound as if your final test result will be the same - negative. Sucks that you have to wait so long to get your "conclusive" result, but, my guess is that as time goes by, and your results stay negative, you will start to breath a little easier.
On another note, I would like to read more about PEP's role in delaying antibody production. I can say that I did read anecdotal reports that it did not delay seroconversion, and yet PEP users are tested out to 6 months. Of course, as far as I know, no formal studies have been done of the effect of PEP on antibody production, so I understand that, without data driven evidence, the advice is to test out to x number of months (even though, in terms of risk, some scenarios would not lead one to believe that HIV transmission had been accomplished). A couple of thoughts:
1. It seems that PEP is being prescribed after events that have only a theoretical risk of HIV transmission (or, a very low risk). How wise is this? And would the testing protocols be the same in these cases? If so, why?
2. Had you to do it all over again, knowing what you know now, would you still decide to subject yourself to PEP?
Just asking for your general opinions on this, as the topic interests me.
Great news!
You're right about PEP being very potent and not without risk. You were probably at much higher risk from that, than from your exposure.
In any event, I'm glad your negative and am confident you'll stay that way.
You're right about PEP being very potent and not without risk. You were probably at much higher risk from that, than from your exposure.
In any event, I'm glad your negative and am confident you'll stay that way.
I had the normal abrasions in my mouth at the time of exposure (cheek bites, etc.), but nothing that was actively open/bleeding.
PEP was not easy. I took 3 drug therapy (Combivir + Kaletra), which is supposed to be very powerful and better tolerated than other regimens. Still, the first 3 days were marked by noticeable nausea. It seemed to get worse with food. Of course, it doesn't help that I take corticosteroids (physiologic/replacement dose) that are also hard on the stomach.
At day 8, I had a terrible drug reaction and had a head-to-toe rash. Since rash is a symptom of ARS, too, and a drug allergy rash and an ARS rash present in a very similar fashion, it definitely didn't help my anxiety. The rash was very itchy, though, and was most intense on my thighs. Antihistamines helped ameliorate symptoms, and the rash continued to subside on its own after a few days. Overall, it lasted 3-4 days.
About 10% of people on Combivir, and 1% of people on Kaletra experience rash. My rash started after a partially missed dose of Kaletra (the pharmacy hadn't had enough to fill my entire order). I made the fatal error of taking an extra pill at my next dose to make up for the missed pills. The rash started shortly thereafter. I experienced a rash reaction to sulfa drugs as a child, too.
I had a PCR/RNA and ELISA the day after the rash; if it HAD been due to ARS, it stands to reason that I would have had a detectable viral load, if not detectable antibodies.
It's very clear that PEP is POTENT, and there is potential for liver damage, so it ought to be prescribed with caution and only with follow-up testing to monitor toxicity. That being said, I'd definitely take it again IF I were to have a high-risk exposure.
PEP was not easy. I took 3 drug therapy (Combivir + Kaletra), which is supposed to be very powerful and better tolerated than other regimens. Still, the first 3 days were marked by noticeable nausea. It seemed to get worse with food. Of course, it doesn't help that I take corticosteroids (physiologic/replacement dose) that are also hard on the stomach.
At day 8, I had a terrible drug reaction and had a head-to-toe rash. Since rash is a symptom of ARS, too, and a drug allergy rash and an ARS rash present in a very similar fashion, it definitely didn't help my anxiety. The rash was very itchy, though, and was most intense on my thighs. Antihistamines helped ameliorate symptoms, and the rash continued to subside on its own after a few days. Overall, it lasted 3-4 days.
About 10% of people on Combivir, and 1% of people on Kaletra experience rash. My rash started after a partially missed dose of Kaletra (the pharmacy hadn't had enough to fill my entire order). I made the fatal error of taking an extra pill at my next dose to make up for the missed pills. The rash started shortly thereafter. I experienced a rash reaction to sulfa drugs as a child, too.
I had a PCR/RNA and ELISA the day after the rash; if it HAD been due to ARS, it stands to reason that I would have had a detectable viral load, if not detectable antibodies.
It's very clear that PEP is POTENT, and there is potential for liver damage, so it ought to be prescribed with caution and only with follow-up testing to monitor toxicity. That being said, I'd definitely take it again IF I were to have a high-risk exposure.
That's great news Strata congratulations. We're all rooting for you and I hope that your luck holds. I'm sure it will:)
Congratulations on your 6.5 negative. I remember when you first posted. You are further than you were in the beginning and I will be praying for you. How has your experience been thus far with the pep? I have heard that it makes you really sick. If that was the case with you I hope you get to feeling better soon. Just a question you were exposed to pre-ejaculate I read. Did you have any cuts, abrasions anything in your mouth at the time? Goodluck, Godbless and I look forward to reading your posts!
WM,
There's nothing 'wrong' per se with the oral swab test. I asked the WWC tech why they had discontinued the use of the oral swab, and he just said it was the new director's policy.
There HAD been some negative press a year or so ago for Orasure based on false-positives with the oral swab test, but I think that's been cleared up (or so Orasure claims). In any case, the bad press was 1+ year ago, and WWC just discontinued the use of the oral swab within the last month.
The oral swab is SLIGHTLY less sensitive than the finger stick test. 99.3% vs 99.6%, but both are considered definitive at 3 months post exposure.
There's nothing 'wrong' per se with the oral swab test. I asked the WWC tech why they had discontinued the use of the oral swab, and he just said it was the new director's policy.
There HAD been some negative press a year or so ago for Orasure based on false-positives with the oral swab test, but I think that's been cleared up (or so Orasure claims). In any case, the bad press was 1+ year ago, and WWC just discontinued the use of the oral swab within the last month.
The oral swab is SLIGHTLY less sensitive than the finger stick test. 99.3% vs 99.6%, but both are considered definitive at 3 months post exposure.
Good to hear that you're neg so far. 6.5 weeks
is pretty reassuring for you.
I'm sure it's a good indicator of what the 13 week
will be.
It must feel good!
Great news about your test. My question is...is there something wrong with the oral swab for the OraQuick Advance? Our testing center here in Atlanta uses the oral swab. Just wondering.
congrats, i know you will be ok. just hang in there, the time will fly by so you can put all this behind you, and return to normalcy. i know deep down inside yourself after hearing everyones post, you know you will be ok.
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