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PEP and viral load

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  • PEP and viral load

    Dear Dr. Tan

    I am currently on PEP, having taken it 43 hours after an exposure at a swinging club. Doctor, I have read a number of articles, including your entry (HIV-1 persistence following extremely early initiation of antiretroviral therapy (ART) during acute HIV-1 infection: An observational study). The articles include (Colby et al - how low can you go? diagnosis of acute hiv infection at very low hiv rna levels) as well as a study in South Africa (Elliot et al - Challenges of HIV diagnosis and management in the context of pre‐exposure prophylaxis (PrEP), post‐exposure prophylaxis (PEP), test and start and acute HIV infection: a scoping review BASHH/EAGA statement on HIV window period). Both of these studies indicate that it can take almost a year before the body produces enough antibodies or HIV RNA > 5,000 copies/ml in the case that PEP hasn't worked. Henrich (2017) also found that “No HIV could be definitively detected for up to 2 years in the participant who initiated ART approximately 10 days after HIV infection”.

    The prospects of waiting this long have left me gutted but I just need to understand if I am reading these articles wrong as well as find out a doctors own experiences. I messed up and I accept the punishment but I would just like closure and to avoid false hope in the case I test non reactive. I am on day 17 on PEP.

    Kind regards

    Svoren
    • Henrich TJ, Hatano H, Bacon O, Hogan LE, Rutishauser R, Hill A, et al. (2017) HIV-1 persistence following extremely early initiation of antiretroviral therapy (ART) during acute HIV-1 infection: An observational study. PLoS Med 14 (11): e1002417.
    • Colby (2018) How low can you go? diagnosis of acute hiv infection at very low hiv rna levels. SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand

  • #2
    Hi Shvoren,

    It sounds like you are concerned regarding not picking up any possible HIV infection and false negative results after completing PEP.

    You might want to check in with your doctor regarding other possible tests other than Antibodies/Antigen detection. If you are concerned regarding the validity of the HIV RNA PCR, you can consider speaking to him regarding the HIV-1 Pro Viral DNA test instead.

    Regards

    Comment


    • #3
      Doc, thank you for your response. My last question as I do not want to spam your forum. When after PEP in 2020 (after experience as well as recent research) can one take it easy. I mean imagine thinking you are negative only for a year later to hear that there was a rebound from these so called reservoirs where HIV is said to hide if ART is initiated quickly.

      So in short, when can I take it easy or maybe begin to start taking it easy and which test should I use?

      Regards

      Shvoren

      *this is my last question*

      Comment


      • #4
        Hi Shvoren,

        You should still go for the HIV Antibody/Antigen check at 1 month after you complete PEP and at the 3 month. Almost all patients with HIV would have sero-converted at the 3 month mark and sero-negative HIV is still a rare condition.

        If still in doubt after that, you can speak to your doctor regarding other possible tests.

        Regards
        HIV Pro-Viral DNA Test (HIV Proviral HIV Test / HIV Provirus) is more accurate that HIV PCR RNA Test. Understand how HIV life cycle work & what's this HIV test.

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