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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.

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563 Comments

  1. Dear Doc Tan, l foolishly had unprotected vaginal sex with a female and started PEP 36 hours later. l had a mild sore throat about 4 days later and 3 weeks later l had a rash on penis which lasted 3 days and disappeared after l applied antibacterial cream. l panicked nd went for hiv test using 4th generation CMIA. lt was 231/2 days Post exposure.lt came out -ve. How encouraging is this?

    • Very encouraging. However, you should still repeat the test at 3 months. Also, screen for other STDs and see a doctor about that rash on your penis. If you wish to see us, you can CLICK HERE for location info.

      • Im currently on pep (truveda and isentress).. it has been 11 days past the exposure.. i understand the window period (antibody testing) for pep is 3 and 6 months after taking pep.. would the rna/dna testing be accurate?

        • drtan

          There is no straightforward answer. Please ask the doctor who prescribed you the PEP.

    • The machine used is for screening blood at blood bank and also did syphilis,HBS and HCV which all came out -ve. Can l do one 6 weeks after exposure. How conclusive will that be? Difficult to wait 3 months.black am a bag of nerves and suffering from panic attacks at times. not a healthy situation.

      • Hello Doc. l asked if a test at 6 weeks or 8 weeks post exposure would be helpful. 3 months is wait is very stressfull. How close is the 24 day test l did compared to 28days? Would the 4 day difference affect the result that much?

        • Chama

          Hello Doc, I did a 4th Generation CMIA test 7 weeks post exposure with is 3 weeks post PEP. It came out -ve. Is this as gud as conclusive?

          • Chama

            Hello Doc, l did a PCR test 28days post PEP and it has come out -ve. Can l move on now?

  2. Precious

    hello doctor, I was exposed to an HIV positive patient on 27th November 2015 and was places on PEP (tenofovir, lamuvudine, efavirenz) 17hours after exposure, its now 16weeks post pep & 20weeks post exposure, my test via 4th generation test is negative, is it conclusive?

  3. Adamu, A.Y

    A brief update sir.
    All test taken were rapid standalone antibodies test. Alere determine, statpak, unigold, healgen, Advanced Quality, star gold ultra, double check were used.
    thank you.

  4. Adamu, A.Y

    Good day Doctor.
    Hoping you will help me.
    I had a blood exposure on 23rd November 2014. (bloody brawl) a couple of weeks later, I fell sick and took the usual tests for malaria and widal and were both positive. I had a full course of medication and got cured.
    however around 68 days post exposure, not feeling well, I decided to run a full blood test for Hep A, B and C, Vdrl, and HIV. all were negative. It was then I told the Doctor about my exposure, the social status of my fight mate and my subsequent illness. He said if I had visited him earlier, he would’ve prescribed PEP for me. He outlined the supposed efficacy of PEP. I become worried and suspects I’ve been infected with HIV. I insisted and was put on 28 days course of pep.
    I took all these tests again 10 days through PEP and a week after its full course all negative.
    from 2014 to date 29th March 2016, I had ran approximately 50 blood test and all are negative.
    I still do not feel fine. no fever. just lymphadenophaty under arms, groin, neck and head plus a faint earache.
    my specific questions are:
    1. can I rule out Hep A, B, C, VDRL and HIV as potential culprits?
    2. would the late course of PEP affect subsequent test results?
    3.though I cannot access pcr test and cd4 count in my location, what further test would you recommend if any.
    while I write you this, i am convinced am the rare case.
    thank you sir.

  5. Hi

    Please bear with me since I’m in a situation/position that I can not see a Dr for some discretion issues. All the info provided below is from self treatment and I need your opinion now.

    I had a risky exposure ( anal/vaginal unprotected sex for 30 min) with a sex worker and was started on PEP(Truvada/Isentress) for 28 day, 30 hours after the exposure. I have completed PEP and took a HIV ab/ag 4th gen test upon completion at a high end lab. I’m currently waiting for my results. Meanwhile I have a couple of questions:

    1- Does my exposure count as two sex acts? Since it was both anal and vaginal? I want to check out my chances of infection in the first place.

    2- I also took ” HBs Ag, HBc Ab, HCV Ab, HSV I IgG, HSV II IgG, HSVI,II IgM” . I was vaccinated for Hep B but it was a long time ago, hence the titr checking.
    Do I need to also test for syphilis and chlamydia or just take some antibiotics for it? I waited upon completion of PEP so there will be no effects from antibiotics on my treatment. Also because the antibiotics side effects might drive me crazy thinking it’s HIV symp.
    Is there anything else I should have checked myself for?

    3- How many PEP failures do you see in everyday practice with my regiment of PEP?

    4- I have some pimples on my butt but this happened after hair removal cream was used. Can this be HSV?

    4- IF my tests come back all neg (fingers crossed), soonest I can be 100% sure is 3 month after exposure or after completion of PEP?

    If there is anything I should do at this point that I have missed, Please advise.

    Thank you for the great and informative website.

    • As much as I empathize with your position, I must say that I do not condone self treatment. That is fraught with risks. Also, this platform is not for dispensing medical advice. So you should not and cannot act on any information you read here. You must still see your doctor. The answers to your questions are just opinions. They are NOT medical advice.

      1. I don’t see how counting it as 1 or 2 sex acts makes any difference to the risk.

      2. I cannot answer this question as it amounts to giving medical advice.

      3. So far none. This does NOT mean that the regime is 100% effective.

      4. I cannot diagnose you over the internet. You should see a doctor to find out if those lesions are HSV or not.

      5. Most guidelines still recommend testing up to 6 months although some say 3 months.

      • You couldn’t be more right and I agree with you. But this is the best I can do now and I appreciate your answers although you tried not to give medical advice over the net which is perfectly acceptable.

        The pimples went away. The tests all came back negative. And I was still protected for Hep B and no vaccine is required. Did another rapid test on day 35 with similar results.
        At this point I think I just have to focus on work and check myself according to guidelines.

        I would appreciate it if you can answer these two last questions at the best you can:

        1- Is my HSV test conclusive on day 28? Or do I have to retest because of the window for HSV?

        Anti-HSV 1&2 IgM -> Neg
        Anti-HSV 1&2 IgG -> Neg

        2-You said you have yet to see a 4th gen ab/ag test on day 28 after exposure (with taking PEP) get it wrong. It this still true?

        • I appreciate the fact that you accept that these answers do not amount to medical advice.

          1. Personally I also screen my patients for HSV at 4 weeks. However, there is scientific info to say that the HSV IgG can take up to 16 weeks to turn positive.

          2. Yes it is.

          • Hi Dr Tan,

            The 2 month HIV ab/ag 4th gen lab test came back negative. I’m more confident now that the 3 month mark will be the same.

            Is the 6 month test necessary or at 3 month, I can consider myself HIV negative and move on?

          • Not necessary. I think you can move on.

      • Hi Dr Tan,

        I don’t mean to accuse you but I’m confused about what you said above. When asked how many PEP failures you see, you replied: “So far none.”. But at the link below:

        http://blog.askdrtan.com/a-case-of-pep-failure/#.VsbZyZN96V4

        You say that you have encountered a PEP failure.

        Can you clarify it for me?

        Many regards,
        Mark

        • His question was specific to his regimen. The failure I saw in that blog post was on a different regimen.

  6. I’m a female. I had protected vaginal sex and unprotected oral sex with a straight male (no ejaculation). Got on PEP 64 hours after exposure. Completed 28-day regimen. 4 weeks after completion of PEP i had an RNA test/4th gen performed. Both neg. Another 4th gen test 6 weeks after the completion of PEP. Another 4th gen test 8 weeks after the completion of PEP (3 months post exposure). Can I finally move on? Thanks.

    • Yes you can. That said, I would remind you that some local health guidelines still recommend testing up to 6 months. You should verify this with your doctor.

  7. Hi sir I would kindly like to ask how conclusive is my 8weeks post pep 4th generation test.it came out non reactive. The truth is I took pep lalate by two weeks and tested beyond three months exposure. Your advice is needed please.

  8. Hi

    I’m a male and had unprotected sex with female SW both vaginally and analy. 40 hours later, I was prescribed Truvada as the only drug. Currently on day 16 and I only had sore throat on days 3 to 6 post exposure, no other side effects.

    1) Worst case, if she was positive, and with the above senario in mind, what are the chances of me becoming positive?

    2) Soonest I can get tested with conclusive results and the name of the test.

    • 1. There is really no logical or practical answer to this question.

      2. This differs between territories. Personally I would be very confident on a 4th Generation HIV test at 4 to 6 weeks post exposure but I will still repeat a 3rd or 4th Generation test at 3 months post exposure. However, this recommendation differs from practice to practice. The best person to advice you is your local doctor or the doctor who prescribed you the Truvada.

      • Hi

        Thank you for your prompt reply. I kind of know there were no answer but I was seeking a way for the peace of my mind. So I guess I only have to wait for the tests.
        1- Do you think Truvada alone is effective?
        2- How many PEP failures have you seen as you confront this everyday?

      • Hello Dr tan,

        I figured no one comes back here to actually post results so other readers can see what the outcome of their situation was.

        I got a 4th gen HIV ab/ag lab test upon completion of PEP (4 weeks after exposure) and it came back negative.

        Another 3rd gen rapid test on day 31 with similar result.

        My doctor was againt the test being conclusive and told me it is a good result but not at all conclusive. He said a 6 month test is. Do I really have to wait that long??

        Thanks

  9. After pep I did combo test and result was negative and once again 1month after pep I did 4th gen rapid antibody test and the result was also negative. Is it conslusive enough doctor?..will still test next month to make it 3 month but i am having serious panick attack worrying it might turn positve next month.

    • In my opinion your tests are as good as conclusive. You should still test at 3 months. Please see your doctor for further advice.

  10. Hi Doctor,

    I got on PEP 64 hours post exposure. After a 28-day regimen, I got tested for HIV with a 4th gen test–negative. At 4.5 weeks after pep (8.5 weeks post exposure) I got another 4th generation as well as an RNA QL test–both negative. Can I trust that I am HIV negative? Thanks!

    • Both of your tests are as good as conclusive. However, the guidelines still need you to retest at 3 months. Please see your doctor for further advice.

  11. Hi sir I was sex with Philippine house maid 3 week before. That time my condom broken. Now I am scared about HIV.so when I take test better. You give me your contact no.

  12. Hello doctors, is the 4th generation laboratory based combo test at 11.5 weeks post exposure conclusive, definitive. Thanks.

  13. Hello Doctors,
    My doctor put in a 4th generation Abbott Ag/Ab combo assay at 11.5(close to 12) weeks post exposure. The result was negative. Is this conclusive and 100 percent definitive?

    • I can only give you general information that the combo test is conclusive after 4 weeks. Whether or not is is “100%” depends on many factors that are outside my knowledge like did the lab make a mistake? was there a mix up in the blood? Was the machine faulty?

  14. Hello doctors, I took a 11.5(close to 12)week post exposure HIV test. This test was the Abbott AB/AG 4th generation immunosay test. The result was nonreactive/negative. My doctor said that the chances that I am infected are exceedingly low. Do yoy agree with my doctor and is this test conclusive. Also, are boils/pimples on butt symptoms of HIV at 11 weeks.

  15. Hi there.I would like to ask how accurate is the 4th generation test two weeks after post pep

  16. After having unsafe sex, i have started pep 56 hrs post exposure. Lymph swelling at jaw and armpit developed during pep and lymph at neck developed one week aftrt the completion of pep. Irony is even after 3 months after exposure (2 month post pep) lymph swellings are not vanished. All developed swells are existing till the time. ie 12 week.aftet exppsure.

    Mean while i have detected non.reactive on 4 th generation duo test carried out on 12 week after pep.

    PLEASE ADVICE. I AM IN A DEEP WORRY

    • Hi, your results shows that you do not have HIV. You should see a doctor to have your lymph nodes swelling checked out.

      • Dear sir,

        Should I need to repeat HIV test. If required which test I have to conduct. ? And when I have to repeat ?

  17. does pep reduce viral replication and delay seroconversion?
    i m on pep and want to test abit earlier so is it alittle abit accurate?

  18. Please answer my question because I am so nervous. Is my 2 week post pep 4th gen Abbott test accurate?

  19. Hello Dr,please answer my question as I am very worried. 2 weeks after pep, my doctor did a 4th generation Abbott HIV test, and it came out negative. Is this conclusive and should i be concerned? Thank you so much.

    • It is not conclusive. But it is very indicative.

      • I am on prep after 50 hours of exposure…continue 14 days…and tested HIV duo…negative…. Is it early after pep?what’s the chance of positive after 4 week of exposure?..I am male with a vaginal exposure with a female..slight insertion unprotected… No ejaculation

        • Your test at 14 days is useless. Why did you even do it? What do you mean what’s the chance of positive after 4 weeks exposure? I really do not understand your question. And why are you on PrEP when you should be on PEP?

  20. Hello doctors, I may have been exposed 8 weeks ago through protected receptive anal and mutual unprotected oral sex with another man of unknown status. Approximately 48 hours after, I initiated PEP.2 weeks after pep, my doc placed a 4th gen abbott hiv test. The result was nonreactive/negative. Is this a good indicator and onclusive?

  21. Hi doc,

    Sorry to disturb, had sex with CSW condom broke, we both tested HIV (-ve). I was on PEP for 28 days and tested with 4th gen combo test immediately after. My result was (-ve) are the results conclusive. Please reply. very worried

    ryan

  22. Hello Doctor,
    I want to know about the combo test, when to take it for sure and is it 100% conclusive and don’t need to text for another 3 and 6 month. thank you.

  23. Hi Doctor
    I had a rapid hiv test by finger prick after the exposure of 28 days and the result was negative (anonymous test at other clinic)
    Am kind of worried still as I heard from the doctor that the result was not conclusive as the antibodies might be found within 3 months.
    Which puzzle me why it is conclusive at ur clinic after 28 days of exposure?
    Please let me know if the result is conclusive or should i test after 3 months of exposure pls ?
    Thanks a lot

  24. Doctor, I asked you a question regarding my post pep test reliability. After a vaginal exposure with a CSW of unknown status ( suspected condom failure). I was prescribed Travuda only Pep. I have had 4,6,8 and 12 weeks POST EXPOSURE, HIV test reported Negative. All 4th generation, lab based tests.
    On 16th Week post exposure I developed a flu like illness, cough,cold. Does it have to do anything with my previous exposure. Or my tests are reliable, I should not worry??
    Do I need anymore testing??
    Please Reply sir!! My Doctor here said I dont need anymore testing.
    I need your opinion.
    Thank you very much.

  25. hi sir,

    I had unprotected oral sex and protected vaginal sex both for 1 minute… I took PEP on the 4th day

    30 days post exposure I went for Alere determine ag/ab 4th generation test (AIDS foundation) and came back negative..

    however, it still shy of 2 days of PEP dose to finish… is the negative result 30 days post exposure and 2 days shy of PEP completion a conclusive result?

  26. Hi sir I’m have HIV pcr DNA qualitative test ofter 28day result noon reactivate and common HIV test offer 4,6,8mnths result negative and ofter 9months HIV pcr DNA qualitative test result noon reactive and ofter12 months common HIV test result noon reactive but I have urine infection sir plz help sir I’m safe or not safe

  27. Hi Dr Tan, I’m curious. When you say the 4 week test immediately after pep is very indicative, are you referring to a duo test or to the Determine rapid test? Thanks

    • Dr Justin Sim

      This is the duo test.

      • Hi doctor,
        Would a duo rapid test done at 6 weeks post exposure (2 weeks after completion of pep) be indicative?

        • Dr Justin Sim

          Yes it is a good indicator but post PEP you need to do an antibody test at 2 months to be sure.

    • I had protected sex with a HIV positive lady. I usually bleed after I brush but she said she doesn’t bleed through her mouth; I also fingered her. Am I at any risk? She noticed her status 11 days after we had sex subsequently I was placed on PEP. 6 weeks after; at the completion of the PEP, I tested negative to rapid test and was told to come back at three months time. I am worried because here in Africa only rapid test is available. can rapid test be conclusive on 8 weeks after exposure; I am depressed and emotionally down. 5 days from now will make it 8 weeks.

      • Dr Justin Sim

        Ideally you should repeat a rapid test 3 months after exposure to be sure. Your results are reassuring and your risk is low with protection but repeat once more for peace of mind.

  28. Hi,
    Thanks for clearing doubts about HIV,
    I have one dout , I took pep with in 12 hrs after my condem broken duringnsexnwith a call girl.
    My base line test in negative ,
    My 3 month and 6 month hiv test also hiv negative .

    My question is , is that result conclucive and no need to worry about hiv.?
    Any possibility to occure positive hiv result after 6 month …
    Need ur urgent clarification , pls support .

    • Even very conservative guidelines say that a HIV test at 6 months post exposure with PEP is conclusive.

  29. thank you so much doctor,may GOD CONT’D TO KEEP YOU AND UPLIFT YOU IN THIS GOOD WORK YOU ARE DOING

  30. Good morning doctor,
    i have done hiv dna/pcr and antibody test at 12week,HABg n HCV antibody,all are negative,could this be conclusive?

    then what other test am expected to carry out.because i still have mild headache and mouth thrust.

    my doctor says nothing is wrong with me but am not feeling ok though am on ciprofloxacine 500mg bd

    • Yes they are. I do not think your symptoms have got anything to do with HIV. If you are really concerned, you may want to get yourself checked for other STDs as well.

  31. SIR, SORRY FOR DISTURBING YOU,IT’S TOO MUCH WORRY.I KISSED A HIV LADY AND SHE SUCK MY PENIS,I TOOK PEP 96HR LATR.I AM NOW 10WK TODAY AND RAPID ANTIBOBY TEST IS NEGATIVE,BUT WITHE SLIGHT HEADACH AND JOINT/MUSCLE PAIN BUT IT’S GRADUAL REDUCING,DR.CAN’T WAIT FOR 2WK MORE,WHAT IS MY FAITH NOW

  32. Good Day doctor

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

  33. actually it was 3 months and a week

  34. Actually 3 months and a week

  35. 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?

  36. I completed PEP for 30days on 14th August,
    I was tested Negative after 5days after PEP? Is it ok?

    • Dr Justin Sim

      It is a good sign but you should repeat a test 2 months after finishing PEP to be sure.

  37. Hi Doctor,

    I just read The new UK guildline 2015 for PEPSE

    http://www.bashh.org/documents/HIV%20PEPSE%202015%20Consultation%20Doc.pdf

    This guildline stats Hiv testing 4-6 weeks after pep finished ( 8-10 weeks post exposure) for conclusive results

    This’s draft document. I dont know how reliable?
    what do you think about this guildline? it’ll publish as guildline as soon right?

    for me , I am very happy to see this guildline.
    I just test negative with gen4 ab/ag and Nat after 8 weeks exposure
    How reliable of my results?

    sorry for my bad english hope you understand me

    Thank you and Best Regards

    • It is difficult for us to comment on whether this is reliable or not. However, what is stated there is consistent with the current practice (HIV test 4-6 weeks after completing PEP).
      Your results were conclusive.

  38. help...

    Hi sir Iam hiv pcr dna qualitative test ofter 28days results non reactive nd1st & 2nd screening test ofter 4, 6,8 months results non reactive nd 9 mnth hiv pcr dna qualitative test result nagitive nd 12 mnth common hiv test result non reactive. .I need any test sir ..pls reply

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