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When to test for HIV during and after completion of PEP

I get this question a lot.

First of all, data on this is lacking and very hard to come by.

There are many theories that hypothesize that PEP reduces viral replication and delays sero-conversion and therefore make HIV testing less accurate. These theories have neither been proven nor debunked.

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Furthermore, there is very limited data on the use of P24 antigen tests (including Combo/Duo tests) and viral load testing for diagnostic purposes in patient who have or undergoing PEP. In fact, studies on monkeys (and more limited studies on humans) have shown positive viral load tests in individuals who were subsequently found not to be infected. This could represent an aborted infection (which is what PEP is supposed to and designed to do) rather than a true false positive. This illustrates one of the limitations of using viral load tests to diagnose people currently on or have completed PEP.

Official Guidelines

The US CDC Guidelines on Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States recommends that patients should be tested for the presence of HIV antibodies at baseline, 4 – 6 weeks, 3 months and 6 months post exposure.

The Joint WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection recommends HIV testing at baseline, immediately after completing PEP (i.e. 4 to 6 weeks post exposure) and again ‘3 – 6 months post exposure’.

The 2 guidelines are rather similar although the US CDC seems to be more firm on the requirement of a test at 6 months compared to the WHO guidelines.

Very recently, the New York State Department of Health AIDS Institute’s adult HIV guidelines committee undertook a comprehensive re-evaluation of its HIV occupational PEP guidelines and issued some changes which included shortening of the time of HIV testing after exposure to 3 months if modern, blood based, standard HIV testing is performed. This is certainly promising however it refers to occupational HIV exposure only and the same data and recommendation may not be extended to non-occupational exposure.

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Summary

 In short, most official guidelines still recommend testing at 6 months for patients who have undergone PEP.

Sometimes testing at 3 months post exposure is good enough but this really depends on what kind of test is done.

My own experience is the test done at 4 weeks exposure (or immediately upon completion of the PEP medications) is very indicative. I will still recommend a retest at 3 months although I have yet to see the test at 4 weeks get it wrong.

At the end of the day, the best person to advise you is still the doctor who prescribed you the PEP. He/She will be most familiar with the sensitivity of local tests available and the local guidelines.

HIV Signs and Symptoms

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Related Articles:More on HIV SymptomsSTD General InfoHIV PEP Treatment at our ClinicHIV CMIA Test AccuracyHIV ELISA Test and HIV ECLIA Test

About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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473 Comments

  1. Good Day doctor

    I have posted a question on the 23rd but I wasn’t replied, please assist me.

  2. actually it was 3 months and a week

  3. Actually 3 months and a week

  4. Hi, i had a negative 4th gen hiv duo teat 9 weeks after pep(30 days) is it reliable? the problem is that i had many symptoms and my blood report was was not normal. is it possible to have hiv symptoms for 2 months and still test negative? my doc says i am ok but i am stressed.

    • Dr Justin Sim

      It is a good result but you should test at 3 months after exposure if you have taken PEP. Abnormal blood results this early are not to do with HIV.

      • 9 weeks after pep is 3 months after exposure,, is it then conclusive? i had other symptoms witch started 2 months before last test. is it possible to have symptoms of hiv witch start 2 months before last test and still test negative if it is due to hiv?

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