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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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818 Comments

  1. kuldeep

    Hi Dr.
    First sorry for my English

    Sir I have my insertivee anal exposure with a transgender I know this is positive I take first dose of pep at 96 hours I know it’s too late. When IAM on pep I take 17 the day of pep pcr rna quantitative & hiv combo test which is elisa (hiv antibodies test screening test and p24 included) which are negative and my index value of antibodies. Test is 0.07. I have taken my last dose of pep on 12 June I again take hiv pcr rna quantitative and hiv antibody test 29 June (at 17 the day after pep stopped ) in which pcr rna result target is not detactable and duo test negative and my index value is 0.09 .when IAM on pep I feel redness in mouth no sore which is come right after 4-5 days automatically doctors say it’s thrush and I take pictures and see to other doctor which say it’s not thrush I feel pain in left shoulder when IAM on pep I feel some redness in collar region which automatically right to in 2 day after finish pep I see to funsi pimple on my stomach may be mosquito bite or any other which take more than week to right . today is 20 the day after pep I fell same redness in my chest . I am afraid
    Please suggest me
    My rna PCR test 17 the day after pep how much right IAM safe or not IAM take pcr rna for hiv 1 only and combo test(hiv antigen & antibodies and p24 included) what can I do

    • Hi, I would say you are quite safe at this point. Please do not look for further symptoms, you will end up making yourself paranoid. You have done what you can with the PEP to try to minimize your risk. I believe your tests are a very good indication that you do not have HIV. At this point, I would only suggest one more repeat test at 3 months post-PEP. Stop worrying, it will not help.

      • kuldeep

        Thanks Dr.
        I read many site pcr rna is 100 % conclusive after 15 days after pep.
        Please comment or I need another Elisa after 2 week please reply I also take test after 3 months

      • kuldeep

        Sorry Dr. But I cannot understand in this thread your reply for alper is that his result u take conclusive but in my case u say it’s good indication . He take pcr rna on 7 day after pep and I take pcr 17 day after pep and duo test I puzzle and I read pcr rna after 15 days 100% conclusive
        Sorry for this type of questions please reply I know my case is more risky because i expose with transgender but testing is not effect this situation they give only results.

        • It is essentially conclusive, but not officially – guidelines will still recommend a repeat test at 3 months.

          • kuldeep

            Pcr rna after 15days or duo test at 28 days is same

      • kuldeep

        Sir there is difference between Altima rna and pcr rna please ckearify please please 🙏

        • Altima is just a brand. It’s the same test.

          • kuldeep

            thanks doctor

          • kuldeep

            today i go to a expereienced hiv specialist he say red spot on my stomach is a mosquito bite. I also see the picture of redness in mouth he say its aartima (LIke i dont understand what he can say) its not hiv.

          • Sir I take duo test 4 generation at 30 day after pep and after 65 day after exposure . I take pep at 96 hours.
            1. Can it be conclusive or I need wait

          • In my opinion, you can consider it conclusive. However, many guidelines will still recommend 3 month testing post-PEP. But for practical purposes, you are completely fine and should stop worrying. You have asked the same question 5x and I have said the same thing 5x. Just move on with your life.

          • kuldeep

            sir i take pcr rna for hiv i at 30 day after pep and duo test 4 generation.
            RNA results is target not detected and duo test index value 0.1 non reactive. how much i am safe please comment sir i waiting your response please please

          • kuldeep

            sorry sir
            iam really very worried but when i read you comment really i feel some happy and feel some safe
            Thanks sir

  2. Isaaci

    Dr I had an unprotected Vaginal sex with a lady and decided to go for PEP about 50 hours later just to be on the safe side. 2 weeks into the PEP I had another encounter with her only to discover at about 21 days post initial exposure that she is HIV+. I continued with the PEP till the 45 day post initial exposure.The baseline 4th gen test P24 is negative. A retest at 60 day post initial exposure and 46th day post 2nd exposure is negative. I have slight headachea and sore throat. Am so worried. Pls can these result be near conclusive while I wait for 3 months post 2nd exposure. Thank you

    • Hi, yes the results are very reassuring and essentially conclusive. You should try not to worry too much. Your final test at 3 months is largely precautionary.

  3. Hello Doctor,

    I entered an unprotective sex with a ukranian girl 37 days ago and after 3rd day of our sex relationship she came out hiv+ from 4. generation vidas duo ultra test

    Later on i started my pep treatment at 85.hour and it continued for 28 days

    On that period , i mean on my pep medication, i entered many tests

    On 14. day 4.Gen Vidas duo ultra and hiv pcr rna => negative
    On 20. day 4.Gen vidas duo ultra and hiv pcr rna => negative
    On 28. day 4.Gen Vidas duo ultra => negative
    On 35. day after finishing my pep medication, 4.Gen vidas duo ultra and hiv rna pcr => negative

    I am still feel worry about the situation and i want to enter 4.Gen Vidas test again after two weeks of finishing pep medication

    Could i please take your professional opinions about my sitaution because this strees is really killing me now

    Thanks a lot for your answer
    Best Regards

    • You are extremely safe at this point, and I would take your results as a conclusive negative. However, as per PEP protocol/guidelines, we would generally still recommend one last test at 3 months post-exposure.

      • Thanks a lot for your kind response doctor
        İ will follow pep protocol as your advise

        Best Regards

  4. Hi Dr,

    Is a negative rapid finger prick test (BioLytical INSTI) at 10 weeks post-exposure (6 weeks after last PEP dose) conclusive?
    I did the test under supervision by Pharmacist where I live.

    I have a lab blood test scheduled at 12 weeks post-exposure but I could not wait until 14 weeks to get conclusive results so I decided to do a rapid test while waiting.

    Thanks for your help

    • It is essentially conclusive but the last check at 12 weeks would be official.

      • Dr,

        Thanks a lot for your reply.

        The HIV DUO Ag/Ab test came back negative at 12 weeks post-exposure.
        This confirms the the INSTI rapid test I did at 10 weeks post-exposure was a very very good indicator.

        Local testing centre still recommends testing at 12 weeks after last dose of PEP but I am not keen on doing it because I am sure it is only as a result of “legal conservatism” in the guidelines and this is a stressful experience.

        I hope this thread of comments proves useful for others in the future.

        Thanks again.

  5. In the US, the architect abort combo AG/AB is the only approved 4th generation test. Would that have the same efficacy as the bio line, which is the one you all use?

  6. Dr Tan,

    My question is as follows: After the taking PEP for 28 days, does the window period begin after PEP or day of exposure? I guess the question is, is it conclusive 3 months post exposure or 3 months after the last dose of PEP?

    • Different countries and organization use different post-PEP guidelines. We are comfortable to call a negative result conclusive 3 months post-exposure.

    • I was possibly exposed to hiv and I started pep 52 hours post exposure. Towards the end of my 3rd week during pep I started having a stiff neck and swollen lymph nodes. I am in my final week of pep should I be worried

  7. Hi Drs.

    On march 26, I had a potential exposure to HIV, it was anal and I was the receptive. so on the 28 which was approximately 56 hours later, I was put on PEPi have tested at different intervals because of anxiety. 6 weeks post exposure (2 weeks post PEP) non-reactive with a 4th generation test. 8 weeks post exposure (4 weeks post PEP) non reactive with a 4th generation test. At 10 weeks post exposure (6 weeks post PEP) I had a rapid Insti test and it was negative. What are the odds that I am infected with HIV? I have had several symptoms such as sore throat for 2 weeks after I was done with PEP as well as night sweats, loss of appetite, loss of weight.

    • Your tests should be pretty conclusive by this point and I think you should not worry.

      • Dr Jonathan,

        The rapid test was just a regular 3rd gen test. Will this have been of any use 6 weeks post PEP. Have you ever seen anyone test positive at 3 months post exposure after testing 4 weeks post PEP on a 4th gen test. I promise this will be the last posting. The reason I am asking is because of my high risk of having unprotected anal sex and being the one receiving it.

        • I have not seen anyone test positive 3 months post-exposure after testing negatively 4 weeks post-PEP with a 4th gen test.

          • Is 3 months post exposure considered conclusive after taking PEP?

  8. k-worried

    This may seem like a strange/ironic situation, but I’m really worried. I am in Bangkok, and I went to a good and supposedly reputable hospital today to ask for PrEP (I have casual sex partners, and I heard PrEP can offer an extra level of protection along with condoms which I always use). The doctor got me to take a baseline HIV test, which turned out to be negative. HOWEVER, I noticed that the nurse who did the blood test, did not unwrap the needle. I didn’t see her unwrap a new one. She just seemed to pick one up from the table where the equipment is and attach it to the rest of the apparatus for taking the blood. I asked her afterwards, and she insisted that the needle was new. I just worry that she may have used a needle that was already used.

    The doctor told me not to worry and gave me a bottle of Recovir EM as PrEP.

    Now I am in a dilemma. If I use the PrEP, it may delay the time when I can go for a test again. But if I don’t, it may be a stupid thing to do.

    I am not saying that the needle was reused, but I just worry that it may have been due to carelessness or an error.

    I am thinking to take the Recovir EM as PrEP/PEP and to test at the end of it (day 28). Would that be reasonable?

    • While I personally feel your fears of the needle being reused are unfounded, it would be reasonable to take a test after your 28 days of PEP if that needle exposure concerns you.

  9. Michealp

    Hi
    I had unprotected oral sex at a massage parlour. The massage lady asked me if i wanted a happy massage – i thought it meant a handjob but soon i felt something strange and opened my eyes and she was giving me a blowjob.I stopped it as soon as i could but i think 20 seconds went by before i could stop her. I got trimming done before the massage and there was a small spot in my foreskin where the skin was broken. It wasnt large – MUCH smaller than 1 cm – about o.3 mm .

    I paid 2000 pounds for pep and started pep. I realise this was wrongly given to me .Anyways I started within 30 hours .

    But now anxiety is killing me . I have a few questions

    1. Iv tested negative with a 4th generation test at 3 weeks post pep. It is negative – is this a good indicator of my status?

    2. I will test again 26 days post pep ( because i need to travel to dubai for my job at day 27 ). I cant travel with this massive anxiety. I am already close to losing my job. Do you think that since the risk was negligible – combined with a 26.5 days post pep testing on 4th generation test – i can put this behind me?

    I understand from reading others posts- that what you tell me is not direct medical advise but just sharing of info.

    • Your risk was extremely negligible to begin with and your negative test at 3 weeks post-PEP is indicative. You do not have HIV, please stop worrying.

  10. Anxious

    Dear doctors,

    Would you find close to conclusive laboratory HIV duo-elisa+p24 test 2.5 weeks after pep, 7 weeks after exposure? Would the hiv duo test + pcr rna 7 weeks after pep/11 weeks after exposure, if negative, be definitive?
    Thanks!

    • Yes, these tests would be conclusive.

      • Anxious

        I have just received the result – laboratory elisa 4th generation test (ab+p24) 85 days after exposure and 53 days after PEP. The result is negative. Would find this conclusive or I need further testing?
        Thanks!

  11. Dear dr Tan,

    I had unprotected insertive anal sex on 7th march. 3days later I found out that the guy was hiv+ (he didn’t know). The next day (90 hours later) I was put on PEP, that I finished 5 days ago. I got tested on 17th day of pep (PCR RNA), ag/ab cmia 3 days after finishing pep. Both tests were negative. I knowam that I must test at 3 months, but, based on your experience, are these results any reliable of my negative status?
    I am so sorry to bother you, but I am extremelly anxious.
    Sorry for my poor english.
    Kind regards.

    • Hi, your tests post-PEP sound reliable so I do not think you should not worry too much. However, as per current guidelines we would still recommend for a repeat check at 3 months post-exposure.

      • Mickey

        Dear, I did another 4th generation laboratory test (elisa+p24), 18 days after pep. It came back negative. Would you find these anywhere near conclusive?
        Best regards!

        • Yes, they are near conclusive.

          • Mickey

            Have you seen case turning positive at 3 months post-exposure, after being negative at 18 days or so after pep?
            Sorry to bother you, but I am very worried. Thanks for you concern!

          • No, I have not encountered such cases. The 3 month repeat test is largely precautionary.

  12. Veryworried1

    Dear Doctor TAN

    THank you for your article . After completing a huge business deal , my colleagues took me to a strip club in switzerland . They bought me a lap dance from a girl from Slovakia . It ended up in 30 seconds of unprotected oral blowjob . I stopped her but later found a tear in my foreskin . I started triple therapy pep within 28 hours even though the emergency said there was zero risk. I was scared and i thus started .
    Im on day 17 today. 11 days more to go .
    Can i test on day 28 – which means the day of termination of the pep ? Is this indicative ? I know you have written that it is indicative but do you think i require more testing after this ?
    Waiting three months will end up with me in depression which i am already fighting . I am married and this has ruined my life . Please guide me

    • You should speak to your doctors with regards to whether further testing is necessary. I am of the opinion that your risk of HIV transmission was negligible from the exposure described, but in general our post-PEP protocol would recommend testing after PEP and 3 months post-exposure again still.

      • Worried sick

        Hello
        Thank you for your mail.
        The problem is that i have no doctor where i am who specialises in Pep or HIV. I am in India.
        This incident took place in Switzerland and the doctor said dont take pep. In fear i took it. I dont have any access to the doctor anymore because he is in Switzerland and not in contact.
        1. What would you recommend to someone in this scenario ? Does it warrant testing if pep wasnt started as originally recommended
        2. Now that iv started pep- can i take the test at 4 weeks and if it comes negative – can i forget about more testing ?
        3. Can i pay with credit card and get telephone consultation dfrom your clinic as i cannot visit the clinic

        • Hi,
          As I said before, your risk was negligible in the first instance and I would probably not have recommended testing or PEP. Therefore you can take the test at 4 weeks and it is my opinion you should forget about it. However, I am just informing you of our own PEP protocol, which is for testing after completion of PEP and again 3 months post-exposure. We do not do telephone consults nor should this be considered any form of official medical advice, just some sharing of information from our own experience.

          • Sahilsahgal

            Thank you doctor.
            I took 27 days of pep and on the 28th day i took the duo test. It was negative.
            As advised by you , im trying to move on. I hope you think my decisions are as per your advise. Just wanted to double check so i can really move on

          • Worriedsick

            Thank you doctor

            I assume you mean take the hiv duo test at day 28?

          • drtan

            Yes. The HIV Duo/Combo/4th Gen. They are different names for the same test.

  13. Elliott

    Dear Doctor Tan and associates.
    Thank you for this helpful resource.
    I have a couple of quite urgent questions regarding the influence of pep on test results/the window period. I say ‘urgent’ because I suffer from refractory major depressive disorder, and my current ordeal is causing considerable ideation, which is alarming me and those around me.
    I am male and had a potential exposure with a female of unknown (but suspect) status in December. Vaginal sex was protected, but I performed oral sex (cunnilingus and vaginal fingering on her). She suffered cervical irritation and began to bleed, so the sex was discontinued. I had cervical blood and vaginal secretions on my fingers and mouth. Here in the UK I was prescribed pep at 30 hours post exposure. I adhered for the full 30 day regime (UK duration). I tested negative at baseline, negative at day 30 (end of pep) and again at day 40 (10 days post pep). I was advised to attend the UK GUM clinic again at 12-14 weeks post pep (this week is week 13).
    I am particularly concerned because at 14 days post pep (4 days after most recent test) I suffered from a very sore, stiff neck for 1 week. (No rash, fever, palpable swollen lymph nodes or throat pain). The pain was localised to the right parotid gland region, though there was no palpable swelling. This was not muscular pain from lifting or posture related. I found information from the Canadian health service advising that ‘stiff neck’ is a reported ARS symtom in approximately 30% of seroconversion cases.
    My questions to you, doctor: 1. How indicative would your clinic consider my negative test at 40 days post exposure (10 days post pep)? (I realise I need to test again at 12 weeks post pep but I am so certain my test will be reactive I have completely lost the courage to revisit the clinic.)
    2. In your clinical experience how common is parotid gland- associated pain, without any other symtoms, during seroconversion?
    Any input appreciated. FYI, the tests were all UK NHS 4th generation duo test (veinous lab tests, not rapid tests).
    Thank you, doctor

  14. NYCworried

    Dear Dr’s, First of all, I’d like to say thank you for the wonderful website and videos. It has kept my sanity (as much as it can) during this past month. I am currently taking nPEP for an exposure with an unknown source (giving unprotected oral when I had a bad sore throat, and protected anal, I don’t think the condom broke, but I didn’t really examine it) that took place on March 7th, and will take my last PEP dose on Tuesday April 4th. I have had some symptoms, swollen glands, light rash on my forearms that comes and goes, lots of stomach issues, headaches, and some muscle pain. I’m not sure if I can attribute those to my high anxiety, side effects of the meds, or actual symptoms if the nPEP failed. 1. Anyways, my main question is when is the earliest I can take a test? and 2. Can my anxiety have caused those symptoms or could they be side effects of the nPEP? The nPEP combination that I have is Truvada and Tivicay both once a day. and 3. Does nPEP affect the window period of HIV tests? Here in NYC the US CDC guidelines are the same for if you didn’t take nPEP, but I just want to make sure!! Thank you again for all you do.

    • 1. Test now. US CDC guidelines recommend testing within 2 weeks of completing PEP and again at 3 months post exposure.

      2. There are many possible causes of your symptoms. I am in no position to even hazard a guess.

      3. There are a lot of theories that say it does but no definite proof. Yes I agree with you. I read the NYHD guidelines. They are easily the most progressive.
      I agree with them that 3 months is more than enough.

  15. Prashant

    Respected sir ,I was exposed to HIV 51 days back . On day 2 and 3 I took truvada and then discontinued.On day 15 PCR RNA and duo test came out negative .on day 28 WB was negative .On day 38 PCR DNA was also negative . I have a doubt . I took only two pills of truvada and then discontinued,so can there be false negatives on day 28 and day 38 tests due to those two pills ? If yes ,is truvada that effective ? 🙁

    • Hi,
      Even if you had exposure to HIV this does not necessarily mean transmission. So given all of your tests done, it is unlikely that you have any HIV, Truvada or not. Please speak to the doctor who treated you and did your tests for more information.

  16. Am I misreading this, or has the CDC updated their guidelines to suggest that testing at 3 months is conclusive for individuals who have undergone non-occupational PEP treatment? The most current guidelines were published in April 2016 and are posted on the CDC website – https://stacks.cdc.gov/view/cdc/38856.

    It states the following: “Repeat HIV testing should occur at 4–6 weeks and 3 months after exposure to determine if HIV infection has occurred….Additionally, persons whose sexual or injection-related exposures results in concurrent acquisition of HCV and HIV infection might have delayed HIV seroconversion. This has been documented among MSM with sexual exposure and healthcare personnel receiving oPEP for needlestick exposures. Therefore, for any person whose HCV antibody test is negative at baseline but positive at 4–6 weeks after the exposure, HIV antibody tests should be conducted at 3 and 6 months to rule out delayed seroconversion.”

    In light of the CDC’s current guidelines and your own experience, would you consider negative HIV and HCV test results at 12 weeks or more after exposure conclusive? Thanks.

    • Hi,
      As stated in our article, there may be small variations in guidelines depending on the organization and test performed. We would agree that testing done post-PEP at 4-6 weeks post-exposure and 3 months post-exposure. Testing done at 6 months post-exposure is essentially precautionary as there have not been any cases of a negative test at 3 months turning positive at 6 months. Please speak to your doctor for more information.

  17. Stabler

    Dear Dr Mastura or associated,
    I wonder if you could elaborate slightly on my two follow up questions to you from my original post dated 30 Jan, which you kindly replied to in early February. Thank you. Stabler

  18. Dear Dr Tan,

    Good day sir! I have 3 questions with regards to HIV testing after PEP:

    1. I have tested up to 25 weeks post exposure with a 4th Gen Ag/Ab test, result: Negative. I did take on PEP from the start for 30 days. Will this be conclusive?

    2. The guidelines mentioned 3 months and 6 months, is this post Exposure or Post PEP?

    3. Is 24 weeks equivalent to 6 months?

    Please advise. Thank you so much!

    • Hi,
      Guidelines on post-PEP testing still vary somewhat from center to center. Most of us are comfortable to test at 3 months post-exposure, with the 6 month post-exposure test as mainly precautionary – there have so far been no cases of patients who tested negative at 3 months that became positive at 6 months. Thus, your 25 week post-exposure test is adequate and you would not require any further testing.

      • Dear Dr Jonathan,

        Thank you for the information! 🙂 so based on what you have said, my results would be conclusive? Even with PEP from the beginning?

        Thank you for your kind replies.

  19. Hi,
    Is a 4th Gen rapid test accurate or even conclusive at 5 weeks post-pep?

    • Alan

      It is not conclusive at 5 weeks post PEP. Official guidelines recommend testing at 3 to 6 months for patients who have undergone PEP.

  20. Hello doc, i had my hiv rna pcr quantitative test result it show no hiv rna detected but values in the test frightens me <70IU/ml though the test is taken on 30th day of last exposure , to again i had rapid antibody blood test in 42 day came back negative!!! Plzz interupt with my result doc and help me usually primary hiv infected person have very high viral load above 10000copies but in my case is it a false positive!!!!

  21. Does PEP really delay seroconversion/ARS symtoms?
    Dear Dr Tan and associates. Thank you for this resource. I have an important question relating to an hiv expose which is causing my severe anxiety and depression and, to be very open, suicidal ideation.
    8 weeks ago I made a very uncharacteristic error in judgement and put myself at what I believe was a high risk expose. I am based in the UK and was offered PEP on the basis of the severity of both my mental health issues and the potential exposure. My risk was this: I am male and engaged in protected vaginal intercourse but unprotected cunningus and vaginal fingering with a woman of unknown status who is known to be highly promiscuous. In addition, she is of Spanish origin, which I know has a relatively high rate of HIV-2 compared to other regions outside of West Africa. I had been celebate for a long time prior to this encounter and made a very foolish error in judgement. The encounter lasted around 2 hours and there was palpable irritation to the female’s vagina and cervix which caused us to disengage in intercourse after about 90 minutes and turn to oral sex (me giving). Since the oral sex was unprotected I certainly had vaginal fluid on my lips, tongue and fingers, I went to a UK GUM clinic at 28 hours post exposure for an assessment and began PEP at 30 hours post exposure. I tested negative for hiv at baseline and adhered fully to pep for the 28 day duration. At 10 days post PEP (35 days post exposure) I returned to the clinic for STI screening (hiv 4th generation duo, gonorrhoea and chlamydia). The tests came back clear. I was advised, however, that I need to return 6 weeks post PEP for an combined hiv duo-syphilis test. That is due next week. I am particularly concerned, to the point I’m unable to even leave bed and have completely isolated myself and not left home for over 4 weeks (since my last test), because of a combination of intrusive thoughts, and the fact that I began suffering physical ailments, which may be symptomatic of acute infection/ARS. The symptoms are not what I’d classify at typical flu like symtoms or anxiety driven psychosomatic symptoms. The symptoms are these: 1 week post PEP I experienced a painful, stiff neck for 5 days (no swelling of the lymph nodes). This was the kind of neck stiffness I’d associate with meningitis. This subsided after 5 days. One week later I began suffering quite extreme discomfort in the creases between my thighs and groin. I have self examined thoroughly and have found no swollen lymph nodes in either my groin or neck. However the localised pain and discomfort in my groin region is becoming increasingly prominent and I’m now struggling to both sit down and stand up without suffering considerable pain. It is a dull, throbing pain and is associated with neuropathic tingling running down my legs to my ankles. I realise hiv cannot be diagnosed on symptoms alone, however, having read reports of seroconversion from patients who have tested positive I note several mention neck pain and tingling discomfort in their legs. I have not suffered the classically listed ‘triad’ of symptoms (fever, rash, sore throat). I need to wait another 2 weeks for my next test but, frankly, I do not think my mental or psychological state will permit me to continue in the state I am in for a further 14 days. I note from older posts frok the likes of Dr Hook and Dr Tan (Singapore) amd Dr Sean (UK) that pep generally dirs not cause considerable, or even any, delay in seroconversion and that a 4th generation duo test at 35 days is reassuring. However, many of their posts are several years old. I wonder if there is any up to date clinical infornation on this?
    Many, many thanks for any information for your response to my post.

    • In my opinion your tests is indicative that you are free from hiv and STI.
      The window period for the 4th generation HIV test is for 28 days post exposure.

      Official guidelines recommend testing at 6 months for patients who have undergone PEP.

      please note that we are unable to verify the accuracy for your test. for that, please ask the doctor who has done the test for you

      However, your symptoms should warrant further medical examination and advise in view of persistent groin pain . You should discuss with your local doctor further to address your mental health issues.

      • Dear Dr Mastura.
        Thank you for replying to my post. Your reply, of course, is reassuring, but I understand that I need to test again for conclusive verification.
        Regarding the physical symptoms I referred to: the neck pain, which lasted 5 days, and began 2 weeks post PEP, and the groin pain, which also lasted 5 days, and began 3 weeks post PEP, I wonder if you’d be kind enough to comment more on the first symtom: the stiff/sore neck? I recently read in Canadian health guidelines that stiff/sore neck is a reported symptom in approximately 33% of ARS cases, however here in the UK it is not listed as a typical symtom. I wonder, in your professional and clinical experience, is a very sore neck approximately 40 days post exposer/14 days post PEP a common symptom of seroconversion?
        Thank you, doctor

        • Stabler

          Dear Dr, or associate, do you have any further thoughts on my question regarding stif neck as an ARS symtoms at 3 weeks post PEP? I am still on the window period and would like input for clinicians, such as yourselves, with direct clinical experience. Kindo regards

  22. Dear Dr Tan and associates. Thank you for this resource. I have a question regarding PEP and seroconversion. I’m in very poor mental health following a potential hiv exposure several weeks ago. And I have an important question relating to an hiv expose which is causing my severe anxiety and depression and tangible suicidal ideation.
    8 weeks ago I made a very uncharacteristic error in judgement and put myself at what I believe was a high risk expose. I am based in the UK and was offered PEP on the basis of the severity of both my mental health issues and the potential exposure risk. My risk was this: I am male and engaged in protected vaginal intercourse but unprotected cunningus and vaginal fingering with a woman of unknown status who it has subsequently been brought to my attention is very promiscuous. In addition, she is of Spanish origin, which I know has a relatively high rate of HIV-2 compared to other regions outside of West Africa. I had been celebate for a long time prior to this encounter and made a very foolish error in judgement. The encounter lasted around 90 minutes and there was palpable irritation to the female’s vagina and cervix which caused us to disengage in intercourse after about 90 minutes and turn to oral sex. Since the oral sex was unprotected I certainly had vaginal fluid on my lips, tongue and fingers, I went to a UK GUM clinic at 28 hours post exposure for an assessment and began PEP at 30 hours post exposure. I tested negative for hiv at baseline and adhered fully to pep for the 28 day duration. At 10 days post PEP (35 days post exposure) I returned to the clinic for STI screening (hiv, gonorrhoea and chlamydia). The tests came back clear. I was advised, however, that I need to return 6 weeks post PEP for an combined hiv-syphilis test. That is due next week. I am particularly concerned, to the point I’m unable to even leave bed and have completely isolated myself and not left home for over 4 weeks (since my last test), because of a combination of intrusive thoughts and the fact that I began suffering physical ailments, which may potentially be symptomatic of acute infection. The symptoms are not what I’d classify at typical flu like symtoms or anxiety driven psychosomatic symptoms. The symptoms are these: 2 weeks post PEP I experienced a painful, stiff neck for 5 days (no swelling of the lymph nodes). This was the kind of neck stiffness I’d associate with meningitis. This subsided after 5 days and one week later I began suffering quite extreme discomfort in the creases between my thighs and groin. I have self examined thoroughly and have found no swollen lymph nodes in either my groin or neck. However the localised pain and discomfort in my groin region is becoming increasingly prominent and I’m now struggling to both sit down and stand up. It is a dull, throbing pain and is associated with neuropathic tingling running down my legs to my ankles. I realise hiv cannot be diagnosed on symptoms alone, however, having read reports of seroconversion from patients who have tested positive I note several mention neck pain and tingling discomfort in their legs. I have not suffered the classically listed ‘triad’ of symptoms (fever, rash, sore throat). I need to wait another 2 weeks for my next test but, frankly, I do not think my mental or psychological state will permit me to continue in the state I am in for a further 14 days. I wonder if you have any clinical advice based on your own experiences regarding seroconversion post pep. I note that abovery you state you have historically found testing immediately post PEP is usually indicative of a patients overall hiv status. Is this still the case?
    Many, many thanks for any information. Yours faithfully.

    • In my opinion your tests is indicative that you are free from hiv and STI .

      please note that we are unable to verify the accuracy for your test. for that, please ask the doctor who has done the test for you

      However, your symptoms should warrant further medical examination and advise in view of persistent groin pain . You should discuss with your local doctor further to address your mental health issues.

  23. Hi Dr Tan,

    Congratulations for website, very good informations.

    I’ve be exposed to a risk and started a PEP 36 hours after the risk (anal sex eith girl that unknown her status – condom broke)

    I’ve been tested ad the following:
    – before PEP: 3 generation test (negative)
    – 40 days after risk (10 days after pep): 3 generation negative
    – 60 days after risk (30 days after pep); 4 generation + p24 negative

    It’s strongly recommend perform test again within 90days after risk or the case can be considered closed (my medic here in Brazil has considered closed the case).

    Sorry to ask this kind of question, but I’m little worried that outside of Brazil they request test till 3 months after risk.

    Thank you in advance

    Mike

    • Different counties and health authorities have different guidelines on when to test conclusively after PEP. I have shared some information in the article above. For your particular situation, you should seek and listen to the advice of your local doctor.

  24. Hi Dr Tan, is a 4th gen test(antigen/antibody) 3 weeks post-exposure whilst still on pep of any use?

    • I honestly do not know how to answer that question. What do you mean “of any use”? It will not be conclusive.

  25. Hi Dr. Tan

    after a low risk exposure (protected sex), i finished PEP and then took a CMIA combo test 3 months post exposure (i.e. 2 months after PEP)

    The result was non-reactive: http://tinyurl.com/j4sojds

    Is this considered as conclusive?

    • PEP guidelines recommend between 3 to 6 months post PEP testing. Please verify with your local doctor what your local guidelines say. We cannot comment on the accuracy of your results. You should verify this with the doctor who did it for you.

  26. Hello doctor. Finished my pep 28 days regime. 5 days after finishing pep 4gen antigen and antobdy testing was negative.

    1. Is it conclusive?

    2. Does a 4 gen antigen and antibody test will be conclusive after 6 week post pep ?

    Thank you

  27. Hi.Dr.Tan i am sara 24 yrs I got pricking while giving cannulation around 3:30 pm and splashing of blood in my fingers for a few drops i.e around 5:30 pm from a patient who had HBsAg and HIV1&2 reactive then after I consult with the Doctor he prescribed me PEP tx i.e tabs.Duovir for 28 days….so I have done test only hepBantibody so Sir will you advice me something cause m really scared tensed Sir

    • I am not sure what kind of advice you are looking for. You had an occupational exposure (I am sorry to hear that) and your Doctor has very intelligently and responsibly put you on PEP. You will just have to finish your PEP and get tested according to your hospital’s protocol. I wish you all the best.

  28. testafterpep

    Dr Tan, After a condom break exposure I took PEP within 24hrs. On the 30th day I tested using a 4th gen combo test and result was negative. Am I in the clear now?

  29. Weekend gettogether

    Hi Doc
    I had a weekend of lot of unprotected intercourse of which I bled after each intercourse with my boyfriend then we tested on Sunday morning of which he tested positive and me negative I then took pep 33 hours later from first exposure . will Pep be effective thou there was too much bleeding and too much hiv exposure

    • As far as I know, the 2 factors you brought up does not affect the efficacy of PEP.

  30. PEP testing

    Hi doctor,

    Thank you for the wonderful work you all do in reaching out to us.

    My scenario is that I had unprotected vaginal sex with a commercial sex worker. Went on PEP 48 hours after exposure and completed the treatment. Now 2 weeks after pep/ 6 weeks post exposure I did a SD bioline combo test. Results were negative.
    1) I would like to ask if this is conclusive?
    2) should I be worried still, since you have not seen a result at 6 week post exposure turn positive later on at 3 months?

    • 1. IMHO yes but verify with your doc.
      2. I do not know how to answer this question.

  31. Hi Dr. Tan

    I had a low rise exposure (condom was used & Intact). 60 hours post this, i took PEP (started with Duovir+Efavir for 1.5 days and the switched to a 30 day Isentress+Tenvir regimen because of efavir side effects) and completed that course.

    16 days after completing PEP (i.e. 51 days after exposure), i tested non-reactive on a 4th generation test.

    1) Is the 51 day post exposure near conclusive?

    2) In this test, the ELFA index value was 0.2 and non-reactive (cut off value as per report is 0.25). But the index value of the test i took before starting PEP was 0.02 and Non-reactive. Is this something to worry that the value has risen sharply over 6-7 weeks?

    I anyway plan to do another test at the 3 months post exposure mark. But am so worried that the index value is so close to the cut-off value of 0.25. Please advise.

  32. Hi doc Tan,

    Have a couple of questions, am a patient at your katong branch wanted to check with doc Jess however she is away this weekend so I can’t have answers to my question.

    I have completed my pep treatment today is day 33 post exposure, 2nd day since completing pep. On day 33 post exposure I did a anonymous sd bioline combo test which was negative. Is this conclusive or perhaps a good indicator that there is no HIV since your experience indicates that the 4th week test have not got it wrong at 3 months too?

    • In my view as good as conclusive. I am sure your test at 3 months will be clear too.

  33. hi dr tan i had sex with sex worker and i used pep for 29 days after that at 6 week post expouser hivab/ag negeative since then i did due test every week until 13 week that it was hiv ab/ag non reactive so after 13 week is this test realiable? i did pcr test but i am waiting for the test result but can i be sure after 13 week?

    • Generally speaking I can say your tests are conclusive. However, there are many testing details I am not privy to. Therefore you should still verify the accuracy of your tests with your doctor.

      • hi dr tan tnx for your answer i get pcr test negative after 3 month so can i be relax?

  34. hi dr tan i had sex with sex worker and i use pep after 3 month i get hiv ab/ag test last week it was .364 this week was .371 the number goes up but its non re active so after 3 month is this test reliable?

  35. Dr Tan,

    I did a 4 Gen Combo test (lab) and RNA PCR test (<100 copies / ml) four weeks after finishing PEP. I continue to suffer from symptoms such as pain in the neck, oral blisters and malaise. Are these tests practically conclusive in your view?

    Is it possible the PEP suppressed viral load to undetectable even 4 weeks after finishing the last dose?

    Thanks.

  36. Hello Sir, I had unprotected sex with a sex worker, although she said she was not +ve, after that I quickly went to doctor and he assigned me tablets of “viraday” for 30 days.I started using it within 11hrs of exposure. I tested -ve after 3 and half months of exposure, should I test again after six months of exposure, coz I had pep for 30 days..?
    Please help me sir..

  37. You mention after PEP … test taken 3 months post exposure is good enough but really depends on what kind of test is done… Can you pls clarify which tests you think meet this criteria. anxious
    Y waiting for my 3 month post exposure 2 month post PEP test and want to ensure I take the right test

  38. Dear Dr,
    I had risk exposure on 26/7/15. I took PEP between 68 to 72 hours post exposure. I finished the course. I had negative result 5 weeks after risk exposure, 1 week after completion of PEP. I had negative anti-HIV 1/O/2 results 22 weeks or 5 months post risk exposure. Please advise of my next tests if necessary. Thank you.

  39. SIR I HAD SEX WITH CSW ON JULY 14,2016 AND AFTER 33 HOUR DR. PUT ME ON PEP AND AFTER THAT I HAD TESTED NEGATIVE AFTER COMPLETION ON PEP AFTER 8 WEEK OF PEP TEST IS HIV RAPID TEST CARD METHOD IT CONCLUSIVE ,BUT FROM 18 AUGUST I HAVE SORE THROAT IS IT SYMPTOM OF HIV
    PLEASE MAIL ME REPLY THANKS

  40. Forget to mention if below points help
    consider that the receptive male sex worker is positive( may be high viral load as many sex workers dont use medicines and treatment).
    2) I do stupid stuff like washing penis with antiseptic and then with hot water cause any high risk?
    3) is my PEP dose correct and timely started? as i dint take any other thing like injection or liquid medicine at start, i just started with tablets.

    Points to be consider if they may help you in analysis and answer to me.
    1) Male sex worker may be HIV+
    2) MY WBC count at that time was 11000( i done health checkup few days before the incident)
    3) I was drunk( but i remember everything that unprotected time is less than 5 seconds)
    4) I am uncircumcised.

    • 1. This will not make any difference.
      2. Yes, it is effective if taken within 72 hours.

      If you are extremely concerned, you can do a HIV RNA PCR 10 days from exposure. However, the result may not be very accurate. Best time to check is 1 month from exposure.

  41. First of all thanks for the wonderful work you are doing.
    Please consider my case as urgent.
    I am a 29 year man, I had sex with a Male sex worker in mexico on 2 October 2016 , I Put my condom and push my dick inside his ass( no kiss and other activity) but condom break during pushing my dick go inside but I quickly withdraw my penis and wash it with anticipate lotion( without water) clean it with soft towel and this time i put 2 condoms on penis and again start sex,i come inside him this time no condom break. The unprotected encounter was for only one jerk. I wash my penis with HOT water and clean it with tissue paper. I was having fear so i go to a hospital and asked for pep but that was Sunday so i could not PEP, next day i started PEP ( after 28 Hours ) The pep was 1 tab of truvada( per day) and 2 tab of kaletra( twice in a day). I am having Truvada + kaletra in morning after Breakfast and kaletra in Night after dinner. I did not miss any dose till day 10. What is the chance of Getting HIV. When i should get test ( As early as possible test).My PEP will finishon 2 nov 2016.

  42. Gary Summers

    Doc,

    I am wondering the rationale for those on PEP testing -ve four weeks after exposure (immediately after PEP) not going on to become +ve later. I would think that due to PEP, viral replication is subdued, resulting in subdued antigen production and hence subdued antibody production. However, once PEP is removed, antibody production is resumed and it will come out to be +ve a few weeks after PEP. The only scenario in which it would be +ve immediately after PEP is when the virus is resistant to PEP drugs and continues to replicate despite PEP.

    Is there a flaw in my logic here? Thanks.

    • That is sound logic but it is not proven by science. There are many things in the body and immune system we do not understand. Example: Why do some people infected with HIV never develop any antibodies? I often warn my patients against trying to figure out their status though “logic”. It never works. Just test.

      • Gary Summers

        Thanks Doc. I tested immediately after PEP using 4 Gen Combo and it was negative. However the symptoms which I experienced are so textbook like without any other possible explanation that I am a bit apprehensive. Nonetheless I will test as per recommended guidelines in 2 months from PEP completion and keep fingers crossed. Thanks.

  43. HI I had sex for the first time with csw on 10thsep. I used condom both the times for vaginal intercourse. apart from that we had kissing touching & hand job. I didn’t remember if the condom breaks as I just removed it and throw it off in dustbin without checking.Now I am bit feverish and diaorreah. I am planning to for 4th gen HIV test on 26th sep. Please let me know how conclusive it will be

    • That is only 16 days after exposure. Your test will not be conclusive. You can consider doing the RNA PCR test for better accuracy. Please check with your doctor. You are welcome to visit any one of our clinics.

  44. Hello,

    A girl gave me an unprotected oral sex 53 days before. I was fear to be infected HIV, so I went to a clinic to have some following tests:

    Day 14 PCR (Negative)
    Day 30 HIV Combo Test (Negative)

    Can I ask those tests are conclusive or not? I am still worried about it everyday. Also, my skin is tunning to be sensitive in these recent day. Is it related to HIV?

    Looking to your reoly soon.

    Jackson

    • In my opinion your tests are conclusive. However, the best person to advise you on the accuracy of your tests is the doctor who did the tests for you.

  45. Gary Summers

    Doc,

    I had a related question and would appreciate your reply. I had an exposure about 3 weeks back. I came down with strong symptoms (chills, feverish feeling but no high temperature (<37.6 degree), very bad sore throat, fatigue, loss of appetite, weight loss of 2-3kg) from day 3-7 after exposure. Since then I have been recovering but there's still some sore throat, fatigue and joint pain. I immediately got myself on PEP after 60 hours of exposure when I first started to feel a bit unwell.

    While I understand any test during PEP is non conclusive, 3 weeks after exposure (18 days after starting PEP + 18 since my symptoms started) I did a HIV Combo test (4 Gen – p24 antigen / antibody with window period of 14 days) with the rationale that if my symptoms were related to ARS, then this test should come out to be positive. However, the test is negative. Would appreciate your thoughts on the efficacy on the test. Thank you.

    • Your symptoms came on much much much too early to be due to HIV ARS. There is no good data on the accuracy of the Combo test during PEP.

      • Gary Summers

        Thanks for your reply doc. I finished my PEP yesterday and have tested negative on 4th Gen HIV Combo (p24 antigens and antibodies ELISA) today. While I understand it’s not conclusive, is it a reasonable indication in your opinion?

  46. Thank you for your reply Dr. My main concern is the rash i developed which happened 2 weeks post exposure. My doctor diagnosed it as folliculitis but he saw it several weeks after. To me the rash looked maculopapular with “small pimples”. Also, my other concernis that my wbc was 15 and lymphocytes down to 15%. Would you still believe that this is not link to ars and my results have been negative because of pep. Do you recomend to test again in 6 months? Or you truely believe that the 11 week duo and 12 week rna are conclusive? Thank you again for your help

  47. Hello Dr.

    I had an unprotec exposure on 6/10 with someone who is positive. I went on pep at 44 hrs after exposure. A few weeks after I developed a rash which I never had before and swollen lymph nodes. I also have had night sweats, my palms are always warm now and I had a lip blister. I had extensive testing but everything has come out negative.

    I have had the following tests

    Duo and DNA 5 days post exposure
    Duo 5 days before end of pep
    Duo and RNA 3.5 after pep/7.5 weeks post exposure
    Duo 7 weeks after pep/ 11 weeks post exposure
    RNA 8 weeks after pep/ 12 weeks post exposure

    I also had a WBC which was elevated. Do you believe this is a sign of acute infection? When should I test again? How reliable are my results ?

    • I forgot to mention that I also have blurred vision and that my rash occurred on my back and dr diagnosed it as folliculitis – which I never had before. Thank you for any advice you could provide. Im going through the worst days of my life.

      • Would you consider the RNA and duo at 8 weeks post pep a good indicator of my status despite my symptoms?

        • Personally, I do not think any of your symptoms are suggestive of a HIV infection and that your tests are all as good as conclusive. Please follow up with your doctor.

          • Thank you for your reply Dr. My main concern is the rash i developed which happened 2 weeks post exposure. My doctor diagnosed it as folliculitis but he saw it several weeks after. To me the rash looked maculopapular with “small pimples”. Also, my other concernis that my wbc was 15 and lymphocytes down to 15%. Would you still believe that this is not link to ars and my results have been negative because of pep. Do you recomend to test again in 6 months? Or you truely believe that the 11 week duo and 12 week rna are conclusive? Thank you again for your help

  48. After late PEP

    I was put on pep 7days after exposure with a HIV partner for 6 weeks.I got a finger prick test at six week mark this is immediately after pep but its 7weeks since exposure. Should I be worried are these results conclusive and indicative?

    • After late PEP

      Forgot to mention the results came non reactive

    • First of all I am shocked that you were given PEP 7 days after exposure. PEP is not useful after 3 days from exposure. Secondly, I do not know what test you did so cannot comment on its accuracy. I suggest you ask the doctor who did the test for you.

      • Thank you for your response. The test I took was Alere Determine Antibody rapid test.Are the odds in my favor?And kindly will late PEP have any effect on my testing for example delaying antibody formation or extension of window period or just any effect

  49. LobsterUP

    Hi doc.

    I had unprotected anal with ejaculation ( i was recepient) and i did bleed after. The sources status was unknown. I went on Truvada and Isentress at 46 hrs after exposure for 28 days. I had negative baseline. 4 weeks after PEP I had negative 4th gen laboratory venous test for antigen/antibody and 8 weeks after PEP it was negative also. I was discharged from further testing. I took a home biosure hiv test at 10 weeks post pep which was negative and had an 11 week post pep hospital test (another hospital) which was negative.

    I’ve only been obsessively worrying as I have had on and off rashes that come and go (along arms or sometimes a few big red blotches on chest) that come and go since finishing pep that has been happening on and off for 13 weeks now.

    Am I conclusive and need not worry?

    • LobsterUP

      Would just like to add I just received a text of Negative HiV again at 13 weeks
      Post pep (17 weeks post exposure) so rashes surely must be unrelated to HIV?

    • Based on your test results, I do not think you have HIV. You may want to get a doctor to take a look at the rashes. I do not think they are related to HIV at all.

      • LobsterUP

        Thanks Doc.

        I went again 19 weeks (15 weeks post pep) for another lab 4th gen test which came back negative. I am finally being referred to a dermatologist. Have been told by nurses I need to put this behind me and stop worrying/testing so I am going to do that now. 7 HIV tests that are negative after PEP should be enough to stop me worrying and 4 HIV specialists and another 4 online specialists (8 HIV experts in total) have all said the same. I’ll leave the rashes with the dermatologist now and see why these have come since the incident/finishing PEP. Thanks again!

      • LobsterUP

        Had negative results at 23 weeks post exposure (19 weeks after pep completion), can I consider myself conclusive?

        Still getting clusters of non-itchy red spots (no other symptoms) on the back of my hands or wrist area that come and fade occasionally… Not sure if im still suffering from
        Some type of allergy rash from the medication. My dermatologist appt referral is a 22 week wait.

  50. Filljose

    Hello doc ,
    I slept with a girl for the first time and our second meeting was in four days time and on that day I knew she was hiv positive . I used a condom which did not break on both occasions .she gave me oral sex on both occasions too . Also she told me she doesn’t not bleed in her mouth as we kissed I do bleed sometimes though .i rushed to my doc who said there was nothing to be worried about . To clear my mind I went to a pharmacist who gave me some arv which I took for 28 days . At I have done the combo test 40 days after exposure and it came negative . Is this result conclusive enough? Also I feel some kind of bites in my throat I am not sure is this is as a result of the medications or it’s a symptom of hiv ? Kindly give your opinion sir .

    • You should have listened to your doctor and not your pharmacist. There was nothing for you to worry about. Officially your test cannot be deemed to be 100% accurate. You need to repeat it at 3 months post exposure.

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