Doctor please help me

[Vikki]

kindly read fully and i am very sorry for my lengthy query,
Doctor, i took pep for unprotected vaginal sex with a massager whose status is unknown after 33 hours of exposure for 28 days and i tested negative (don't know which test but blood was taken from my vein, and the result was produced within two hour). Right after completion of pep, i felt fatigued which went away in two days and then again i felt burning sensation on my feet and hand which was there while taking pep on 3 rd way which went away when i continued taking pep, now its 14 th day after completion of pep i am having cough mostly wet cough which is felt after eating(triggering me to cough at my throat), i am completely paronoid towards hiv , started reading about hiv, seroconversion , delayed seroconversion, pep failure so many literatures, paper regarding hiv stuff, i heard after taking pep, if pep is failed you will have symptoms at 2 weeks after completion of pep, i am completely stressed out and having depression and i also heard female to male transmission is near to zero and even i have done circumcision and not having ulcers on my penis. please take my case as a study and please evaluate whether i have to worry for hiv or not?
even she is positive and she infected me will the pep save from the hiv since i have taken after 33 hours of exposure, i am losing my life because of this please help me moreover i am planning to do 4th gen Ag/Abody test at 90 th day of my exposure or should i take now itself ? i have enclosed my blood test , kindly review that too .

• More details about the presenting complaint:
  DOES PEP DELAYS SEROCONVERSION AFTER 2 WEEKS OF COMPELTING PEP?
• Past medications of the same issue:
  Tenofovir emtricitabine dolutegravir pep

BLOOD TEST RESULTS (blood was taken from vein and result was given within two hours)
HAEMOGLOBIN - 17.00 mg/dl
TOTAL WBC COUNT - 9000 cells/cmm
DIFFT:COUNT :POLY - 52 % :LYMPH - 45 % :EOSIN - 3 %
E.S.R - 06 mm/hr
S.CREATININE - 0.70 mg/dl
UREA - 26.0 mg/dl
SUGAR(R) - 75.0 mg/dl
S.URIC ACID - 5.50 mg/dl
HIV - NEGATIVE
GROUPING - ''A1B''
RH TYPING - POSITIVE

[Dr. Zeng Shanyong]

Hi Vikki,

PEP does not delay seroconversion. If you are tested with a 4th Generation Ab/AG test kit at Day 28 after exposure and the test is negative, the test is conclusive.

Regards

[Vikki]

Thanks doctor, but two more question, i had vaginal sex in unprotected way but there was no blood involved even the sex lasted for les than one mintue , what is the risk of getting of Hepatatis C virus ? do i have to look for that too? ( had some buring sensation over corona of the glans of penis after sex may be due too poor lubrication is that a concern?)
then last question, many of the hiv positive are saying female to male is more unlikely or almost nil for hiv transmission is this true doctor? (YouTuber name: jennifer vaughan)

[Dr. Zeng Shanyong]

Hi Vikki,

Hepatitis C can be transmitted sexually, hence if you are worried you can screen for it as well. However, it does not cause burning sensation over the glans penis.

I'm unaware of the fact that transgender patients have lower risk for HIV transmission. I would think it still depends on whether it is vaginal or anal sex, with anal sex having higher risk of HIV transmission.

Regards

[Vikki]

thank u sir, i had vaginal unprotected sex with a women sir, she is a massage center girl, many of them are saying HIV is more likely transmitted from male to male sex, male to female, but in the case female to male it is nearly impossibe while having vaginal sex . is that true sir in your experience have seen any female to male hiv transmission through vaginal sex
What is the window period of HCV virus? does it delay seroconversion of hiv ?
Have u seen any pep failures within my 33 hrs of timeframe? i have completed my pep with full adherence for 28 days
Thank you for answering my query

[Dr. Zeng Shanyong]

Hi Vikki,

There are definite cases of female to male HIV transmission through insertive vaginal sex.

Window Period for testing of HCV is around 1 month. There are some question of co-infection with HIV and HCV leading to delayed sero-conversion. So if the patient is infected with HCV we would recommend extending the period of testing for HIV up to 6 months.

Personally I have not encountered any PEP failures.

Regards

[Vikki]

Thank you sir i will let you know my results on my 90 th day of my exposure

[Vikki]

DO you recommend to test for HCV in my case?
since it was a vaginal sex with no blood involved is it necessary to take any test for HCV?

[Dr. Zeng Shanyong]

Hi Vikki,

HCV can be spread through sexual contact as well. You can speak to your doctor regarding testing for HCV as well.

Regards

[Vikki]

doctor told no need for hcv test so i don't need to take HCV test sir, even so if take hcv antibody test after 6 week is it conclusive? please answer this alone?

[Dr. Zeng Shanyong]

Hi Vikki,

Yes if it's taken 6 weeks after exposure it is conclusive.

Regards

[Vikki]

DOCTOR, is masturbation and nightfall of semen is okay while in pep does it reinfects ?

[Dr. Zeng Shanyong]

Hi Vikki,

No.

Regards

[Vikki]

Doctor, In your website you have told if 4 th gen Ab/Ag CMIA test is used at 3 months of post-exposure is 100 is conclusive . Is the 4th gen test even considered to be conclusive at 3 months even if he has hcv infection ? since in your website it is given that ''The latest published guidelines have not mentioned HCV prolonging the HIV testing window period. This could be due to the fact that most guidelines now recommend the 4th Generation combined Antibody/Antigen assay as 1st line screening for HIV infection."
If i test using 4th gen ag/ab test at 3 months is 100 % conclusive considering all concerns like HCV co-infection , PEP use, etc..,

[Dr. Zeng Shanyong]

Hi Vikki,

The 4th Gen Ab/Ag will be conclusive at 3 months even with PEP use.

I actually would still stick to the previous guidelines of prolonging window period testing with HCV/HIV co-infection. This is as so far we do not have any new guidelines specifically referring to cases of co-infection and hence I would still refer back to the 2001 US CDC Occupational Guidelines.

If you are still worried about HCV, the best way to allay those fears is to just check for it.

Regards