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PrEP to PEP to PrEP

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  • PrEP to PEP to PrEP

    Hello Dr. Tan, below is my situation and I am awfully worried of a delayed seroconversion. Below are the chronology of events. Please do advice.

    I had been on PrEP for two (2) years prior to this and had never missed a dose.

    Exposure: 18th December 2020, 7:30 PM
    Exposure was – potential brief penetration without condom, put a condom on, and realized that there are blood discharge on/in the condom. Due to the scare I went to a doctor (it was at a remote area) to get a proctoscopy done. No anal bleeding or anal fissure was found.
    - Zithromax Jab was provided.
    - Ceftrixon was given
    - Proctoscopy was carried out
    Took additional dosage of Truvada due to scare.

    Starting PEP: 19th December 2020, 10:00PM
    I had started to switch to PEP at the 27th hour after exposure as adviced by doctors. I was given the combination of Truvada (PREP) and Tivicay.

    Ending PEP: 15th January 2020 – 10:00PM
    28th Dose of PEP was on this day, took the additional two (2) pills as there are some left in the bottle.

    HIV Testing: 16th January 2020 – 7:00PM
    HIV 4th Generation ECLIA test conducted on that day, which is 27 days 21 hrs instead of the 28th day.
    Results – NEGATIVE.

    False Negative.

    Saturday March 14, 2020
    HIV rapid testing 4th gen kit - Negative.

    Total days after exposure: 12 weeks 2 day, - 86 days after exposure.

    Total days after completion of PEP: 8 weeks 2 days - 58 days

    Wednesday, 13th May 2020
    4th Generation ECLIA test - negative.

    Total days after exposure: 4 months 25 days after exposure.

    Total days after completion of PEP: 3 months 25 days

    Concern: False Negative due to potential delayed seroconversion due to PrEP continuity after PEP.

  • #2
    Hello Elton91,
    Based on the history that you have shared, and the multiple test results that came back negative, you can be assured that you are not infected with HIV. A 4th generation testing will cover antigen and antibodies, and can be considered conclusive from 28 days post-exposure. As protocol, a repeat testing is advised 3 months post exposure, which you did and it is negative. You do not have HIV.

    Hope this helps.



    • #3
      Hello Dr Meneka,

      Good evening and thank you for your reply! Thank you for your reassurance, however my concern lies on the part where PrEP May delay seroconversion. As I was on PrEP then went on PEP then PrEP again.

      Should I be concerned on this?

      Thank you!


      • #4
        Hi Elton91

        PrEP does not lead to delayed seroconversion. If you are still worried, you can proceed with the HIV ProViral DNA or RNA PCR test which does not depends on antigen/antibody formation for detection of HIV