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Pep to prep transition

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  • Pep to prep transition

    I was 3 days into starting Prep when I had a potential exposure. I started taking prep on the Thursday and on the Saturday I had brief unprotected, receptive anal intercourse with a man of unknown status. There was no ejaculation.
    Also later that same evening I performed oral sex on another male partner and he ejaculated in my mouth. I immediately spat it out.
    I continued taking prep however 2 days later (60 hours) I returned to my Prep provider who said I wouldn’t have been adequately protected and therefore gave me an additional pill to take with my Prep, effectively putting me on PEP.
    One week later, 11 days into Prep and 6 days into Pep, I had another encounter with a male partner. I performed unprotected oral sex and had protected anal intercourse.
    After completing my 28 day Pep course I seamlessly continued to take the rest of my prep.
    13.5weeks after the initial ‘exposure’ I had a 4th generation
    Lab test done which was negative. My doctor said that this was conclusive.
    Since that test however I have experienced terrible muscle and joint pain with no obvious cause. This has lasted almost 6 months now and ranges from mild to severe.
    At 24.5 weeks later I returned to my provider and expressed my concerns and requested a rapid HIV test and also a 4th generation lab test done. Fortunately these also came back negative. However I am still having these unexplained horrible muscle and joint pains which are causing me terrible anxiety.

    My questions are-

    Can I rely on these negative results as being conclusive?

    Or because I went from Prep to Pep and then to Prep again could this have delayed infection and therefore elongated seroconversion and widening the window period?

    I’ve read online that a test post Pep can only be considered conclusive 6 months after Pep is finished, is this true?

    im very confused and anxious.

    ive not had any sexual contact since this episode and have never missed a single dose of prep.

    Thanks for you time in advance

  • #2
    1. Yes you can. You clearly are not infected with HIV.
    2. I have some comments on how you switched from PrEP to PEP but that is all moot. The fact is your tests are conclusive.
    3. 3 to 6 months depending on your local guidelines

    My 2 cents worth: You do not have HIV. Something else is obviously causing your symptoms. See your doctor to find out what. I think once you know what is causing your muscle and joint pains, you will be much more relieved.


    • #3
      Thank you so much for your speedy response Dr Tan Kok Kuan
      it is much appreciated.

      Please have a safe and peaceful weekend.

      Much gratitude.


      • #4
        Dr Tan Kok Kuan

        Sorry to trouble you again Dr and I am very grateful for your previous reply it has given me a lot of comfort and reassurance but after digesting your response fully I’ve just thought of a few more questions.
        Again I apologises for taking up any unnecessary time. I realise you must be a busy man.

        I was just wondering that if some guidelines state that only 6 months after the ‘completion’ of PEP can a result be considered conclusive then how and why are you and my doctor so confident that my 24.5 week ‘post exposure’ tests are conclusive when:-
        a) it is not only Significantly shorter than 6 months’ post pep’ guideline (4 weeks) but...
        b) I haven’t ceased medication at all but seamlessly continued with Prep.
        c) would prep perhaps not potentially weakened my immune response therefore possibly hindered antibody production resulting in a false negative test?

        Obviously I want nothing more than for your expert words to be true and correct but naturally because of my random bodily aches and pains I have my fears and doubts.

        Please again accept my apologies and thanks


        • #5
          Dr Tan Kok Kuan Dr Taufiq Rashid

          Dr, please could you or one of your colleagues respond to my above post?

          I’m very anxious

          Thank you


          • #6
            Yes some guidelines recommend 3 months, some 6 months
            That is why I tell people on this forum to follow their local guidelines
            The fact is the testing technology and capabilities differ from place to place
            That said, with current common available tests 3 months for PEP users is more than enough of a window period
            This would be an issue only if your lab or Dr was using very very outdated tests

            There is no evidence that PrEP delays seroconversion
            So to say that your results will be inaccurate because of PrEP is not based on scientific evidence
            It is pure conjecture


            • #7
              Dr Tan Kok Kuan
              Thank you doctor.

              Your words are very reassuring and your time greatly appreciated.

              I did however stop prep a week ago and since then my body aches have increased. I’ve had a mild temp, sore throat and diarrhea.
              Could I be seroconverting now 10 months later?

              Thanks again


              • #8
                Seroconversion at 10 months? Never heard of it


                • #9
                  Dr Tan Kok Kuan

                  Hello doctor I had unprotected sex on June 8 2019 in paris . Then I went hospital emergency room at 66 hours and prescribed pep for 28 days.I was hiv negative at 6 weeks/ 12 weeks and 17 weeks (4 months after exposure and 3 months after pep). All test were 4 th generation. Am I hiv free or should I test again? Thank you in advance
                  Last edited by tontonamsa2; 12-23-2019, 08:26 AM.


                  • #10
                    Hello doc
                    could you please see this