dear Doctors
I would love to know your opinions on my situation based on an exposure six weeks ago. Took PEP (truvada) while working in South Africa. From what I now know, my exposure was supposedly very low risk but didn't seem so afterwards since we had both had very recent dental surgery, me two weeks since wisdom teeth removal, her two days since molar removal, which I realised afterwards. There was no sex, but lots of kissing, fingering, put own fingers in mouth once for lubrication, no oral sex on me. PEP seems to have have been over reation, but I couldn't find good advise where I was and she didn't want to get tested. She is from highest infected region in SA, plus highest affected age group, so therefore the world. Since her last test two years ago, she has had unprotected sex with one person, but many times..
Initially I wasn't too worried about my exposure, but after two weeks, I randomly got a fever for a few days, and then swollen lymph nodes by the neck, and groin.. still have sore throat and swollen groin lymph nearly a month later though not as bad. Have lost one stone in weight, mainly muscle, I am normally very sporty, but no interest at the moment. No rash or nausia.
Upon returning to the UK I was convinced this was hiv related as too much of a coincidence, but then tested negative for a duo test at 21 days and 28 days. My symptoms started at 14 days and were present during both those tests. Negative for all other stds.
I understand the fact I took pep could render those duo tests much less reliable as the virus would have been surpressed, but is there any encouragement that they were negative?
I had hoped that the symptoms and weight loss / swollen glands might be unusual side effects of PEP and would stop when I finished the pep but they have continued, though lessened a bit. Incidentally I felt a kind of uncomfortable reaction to the truvada almost immediately and missed day 5 while considering to stop taking it, but then felt I needed to complete it after hearing more about her history, and not knowing where to get advise. The doctor I saw here thought HIV was highly unlikely and think anxiety might be causing much of this, and advised me to get blood tests for other things. though I am still concerned.
Is there any point in doing another duo test two weeks after pep (ie six weeks later). If so how much significance would those results carry? Many many thanks in advance for your thoughts..

[Dr Sean]

Hello,

This all seems very tame and as you say, the PEP an overreaction.

I understand the fact I took pep could render those duo tests much less reliable as the virus would have been surpressed, but is there any encouragement that they were negative? yes, I'd be encouraged - the event itself, despite your fears was innocuous. Our experience of using early DUO tests after completion of PEP is that if they are negative they are extremely unlikely then to become positive at 16 weeks (the recommended testing interval)
I had hoped that the symptoms and weight loss / swollen glands might be unusual side effects of PEP and would stop when I finished the pep but they have continued, though lessened a bit. Incidentally I felt a kind of uncomfortable reaction to the truvada almost immediately and missed day 5 while considering to stop taking it, but then felt I needed to complete it after hearing more about her history, and not knowing where to get advise. The doctor I saw here thought HIV was highly unlikelyI agree entirely and think anxiety might be causing much of this,agreed and advised me to get blood tests for other things. though I am still concerned.
Is there any point in doing another duo test two weeks after pep (ie six weeks later).it will reassure you but again, it is not certain at that interval If so how much significance would those results carry?as above - it wil be reassuring Many many thanks in advance for your thoughts..

On balance I don't think you had an exposure; you took all necessary steps by taking PEP; the tests you have had are very likely indeed to be accurate and I do not believe you are infected with HIV.

best regards, sean