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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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924 Comments

  1. I just finished my trivenz treatment but during the treatment I was on test every day on rapid test and two on elisa test till I finished the treatment two-days after i finish I still test negative all through I know that I should have wait for 28 days after trivenz treatment but my question is
    1- is it a good sign for all the test to be negative during and two days after completing trivenz treatment.
    2- I think if the treatment did not work during the treatment I think after completing the treatment my test should not be negative because cause of the treatment is one month

    • Dr. Julian Ng

      Hi,

      If you have finish the PEP and then repeated the HIV 4th Generation Combo test and it is negative, you do not need to repeat it.

    • hivtestingq

      Hello doc ,

      I had an exposure on jan 20th with unknown female partner .. unprotected oral and vaginal sex .. she tested two weeks after the incident with orasure and tested negative .. i started pep (truvada and isentress) at 45 hours and successfully completed the course for 28 days without missing a dose .. i then tested today at 6 weeks ( post exposure ) with 4th gen ag/ab test with reflex and it came back negative .. i also tested for hep a ,b,c ,syphillis .. all negative … i have no symptoms .. do u think my test is somewhat close to conclusive .. my doc suggested to take another test at 4 months post exposure to get conclusive results ? Do u think 3 months post exposure will be good enough .. i live in united states

      • I believe your tests are essentially conclusive. 3 months post-exposure will be fine.

        • hivtestingq

          Thanks doctor –
          1. have you seen a case which tested negative at 6 weeks and then positive later on assuming there are no further exposures and if pep was taken corectly?
          2. You said my tests are conclusive but i just tested 2 weeks post pep. Is ghat good enough?
          3. Also – have u seen a case of truvada/isentress pep failure in your career?
          4. Any other tests you recommend between now and 3 month post exposure mark

          • hivtestingq

            Hello doctor ,

            It will be really helpful if u can answer my qs .. ur opinion will mean a lit to me

        • hivtestingq

          Thanks doctor –
          1. have you seen a case which tested negative at 6 weeks and then positive later on assuming there are no further exposures and if pep was taken corectly?
          2. You said my tests are conclusive but i just tested 2 weeks post pep. Is ghat good enough?
          3. Also – have u seen a case of truvada/isentress pep failure in your career?
          4. Any other tests you recommend between now and 3 month post exposure mark

  2. Hello Doctor, and thank you for all you do.

    Im a little confuse. I had vaginal sex and condom broke, i contracted clamydia and hsv2. My Dr gave me PEP 9 days after exposure which was too late ans i only took ut for a week. Ince then i’ ve taken 4th generation test at 3,4,6,8,10,12 and 13 weeks post exposure, all negative. However he wants me to test at 6 months again. I read cdc 2016 guidlines and it states 12 weeks just like you.
    1)Do I need further testing
    2) have u ever seen a case like this chamge after these many test?
    Im just asking because my Doc do not seem to be updated with PEP guidlines. Please advise, do inreally need to test again?

    • You should not be on PEP 9 days post-exposure. The evidence is only for effective prevention within 72 hours. That being said, I would consider your tests essentially conclusive at this point.

    • I have had unprotected anal sex with a guy, I was the intersive part. 46 hours I begin PEP.
      4 weeks after exposure (1 Day after PEP) ihad a PCR and Duo test – negative.
      7 weeks after my exposure (3 weeks after PEP) i had a Duo test – negative.
      8 weeks after exposure (4 weeks after PEP) i had a RNA /PCR test – negative.
      10 weeks after exposure (6 weeks after PEP) i had a Duo test – negative.

      That is reliable and end results? It Can Not be changed?

      Sorry my english. I from Denmark

      Best Rasmus

  3. Hello Dr, I started to be a Hiv activist I have certain querys:

    1. During the course of PEP if some one again had an Exposure does the PEP have to be extended for another 28 days from the 2nd Exposure ?

    2. Why dont doctors give PEP as PrEP. Even PEP is a better prevention strategy where 3 ARVs are given even it will stop the replication of Mutated virus. Can PEP be given as PreP for the aboce reasons ?

    3. Does the same Drug given for PEP will it work again if some one had a 2nd exposure again after some months or Few days ?
    For Eg: On 1st Oct the person had an Exposure and used Truvada+Isentress as Pep.
    He again had an Exposure in the next few month’s will the same drug Work Again ?

  4. greg worried

    Dear doctor,

    I had insertive unprotected exposure with a message girl.

    Baseline negative.

    Completed PEP 28 day course.

    Started having spots on my stomach, one acne on both side of trunk after PEP.

    Entering 4th week post PEP.

    Highly stressed,hoping the above is more due to stress, etc. Constantly reading and looking at myself for possible symptoms.

    Planning to test in the coming days with 4th gen.

    Would like to know if false symptoms can be be stressed induced & would a negative at 4weeks post pep be a good indicator. Thank you

    • 4th gen testing after completing PEP is a very good indication (essentially conclusive). Stop looking for symptoms as it will not help in any way.

  5. MichealEagle

    Hello doctor,

    I did a teat 3 days after finishing my Pep course. It was negative it while i was getting tested I realised I had sore throat and mouth sores. If these were hiv related, would I be teated positive?

    • I would consider your testing essentially conclusive. But as per post-PEP guidelines, it is best to repeat one 3 months post-exposure. I certainly do not believe your symptoms are due to HIV given your negative test result.

  6. Pep and testing

    Hi Dr ,

    When to test after taking pep ? There is a diversity on the internet and between different countries , some says 3 months after exposure aome says after 4 months and other 6 months ( because of coinfection with HCV . Which one is the correct guidline in your opinion ? Did u ever see someone seroconverted after 2 moths post pep ??? And my last question can the side effects of tenovofir last months after stopping pep such as muscles and joints pain with a negative test 2 months post pep ?? Please i need your answer

    • We would consider testing at 3 months post-exposure to be conclusive, even with PEP taken. I do not know of any patient who tested negative after completing PEP and then positive at 2 months post-PEP, unless they had further high risk exposures or did not take the PEP correctly. You would not have side effects like muscle aches or joint pains from PEP lasting 2 months post-PEP.

  7. Pep and pcr test

    Hi dr.,

    I did a hiv PCR test 2 months post pep and it was negative ( detection 20 copies/ml ) could i consider my test conclusive or i need more testing.
    Please advice.

    Thank u in advance.

  8. I have vaginal exposure last year December. I am taking 30 days of PEP after 25 hours of exposure. I am about to complete pep course. The question is when should I go to test after last course of pep? Should I need to wait another 24 hours or a week or can I go immediately after I finish it? Does pep will affect the Hiv test result?

  9. Vhahangwele Mulelu

    Hi DR, Had exposure with a woman i realized is positive later. I did a test 2.3 weeks post exposure while on pep (Roche COBAS Ampliperp) – Negative. i Did a rapid finger prick test at 12 weeks post pep and it was negative as well. would you consider my results conclusive looking at the type of test i did?
    thanks so much

  10. Postpeptest

    Dr dr jonathan,
    I got today my 12.3 weeks test post exposure and 8 weeks post pep it is negative , do i need further testing ??? But i still have muscle , joint and bone pain.

  11. Hello Dr
    i took PEP for one month i had a n exposure with the lady i found out that was positive later. i begun PEP at the 25th hour. i did a test after PEP and i was negative, did another after one month post PEP and it was negative, today marks my 12th week since i finished PEP and have done a test and it has come out negative. Doctor but i have pain in the neck, i have fever doctor put me on quinine finished the dose but it seems my fever is persistent. what do you have to say doctor?

  12. Postpeptest

    Hi dr Tan,
    I had a vaginal exposure with a woman and I took pep before 24 hrs for 30 days , I tested negative with a duo test at 11.3 weeks post exposure . Can my test change at 12 weeks post exposure ?? How reliable is my test ? I had muscle and joint pains that don’t go this is my 8 th weeks like that and a burning sensation on my face under my beard ( below my nose ) that turn red and come and go . Could this be from hiv infection (ARS symptoms ) ? I have no fever and no swollen lymph till now .
    My last question is the 12 weeks post exposure or post pep is conclusive ? ( I tested negative for HCV also).
    Thank you in advance Dr.

  13. Hello Doctor.

    I had vaginal sex but unfortunately the condome broke. I was diagnose with HPV2 and Clamidia after the incident. I tool PEP after the 2nd week for 6 days, however, i stopped because i realized it was too late. i had 4th Generation Test at 21, 28 and 46 days,all negative, based on your vast experience.

    1)can i considere my test conclusive.
    2) Have you ever seen a 4th Gen test Change after 6 and a half weeks?
    3)Can PEP affect my results since the last test was taken 29 days after last pill of PEP. Thanks for all you do

  14. Worried2much

    Hi DR,
    I did a 4th generation test duo 6 weeks post pep and it was negative, how conclusive it is ( 10.3 weeks post exposure) ?
    Thank you.

  15. Hi Doctor, I would appreciate some clarifications regarding my exposure and testing during PEP. 25 days back I met a guy online (assuming he had multiple exposures) and we had sex. Before we proceed I asked bout his status and he said he is negative (but we cannot trust it till he is tested which he refused to do). He did use condom while penetrating me as I was the receptive guy. We changed positions few times and he re-entered with the condom still on. When he about to finish he pulled out and I took off the condom and proceeded with giving him a handjob till he ejaculated on his tummy. I didn’t do oral on him only French kissing involved. When we were done, I was about to clean myself up, I realised the were blood spots on his lap and a drop on the bedsheet. I wiped my back with a piece of new tissue and there were blood spots on it. I cleaned myself afterward. Went to see the doctor next day to get my exposure assessed and the doctor said it was a low risk situation. Somehow I demanded for PEP and started with atripla 43 hours post exposure. After 10 days of atripla, at day 11th of PEP I changed to truvada and isentress till now day 23rd due to bad side effects of atripla. I’m dealing with severe anxiety right now and I feel like my body is experiencing symptoms but nothing major. I went in for combo rapid tests at day 14th and 23rd post exposure and both came back negative. I still have 7 days to go before I finish my PEP course and I will get tested upon completing PEP. What do you think about my situation and were the negative results twice are good indications?

    • I would say the exposure risk is fairly low. The tests during PEP are a good indication but you will need to repeat testing at the end of the course and 3 months post-exposure as well.

      • Thank you for the reply and I appreciate it so much. Noted on the future tests. But in your personal view do you think the results may differ or it’s unlikely to differ? Plus I changed my meds halfway and never missed a dose yet except time the pills taken were not synced at times.

  16. Lorenzoleb

    Hi Dr.
    I took viraday as pep for 30 days after a unprotected vaginal intercourse with unknown status woman, i got a PCR test afer 20 days post pep and a duo test 5 weeks post pep and both was negative how conclusive are my 2 test results ?

    • They are very good indication, but for conclusive results you would need to repeat one at 3 months.

      • Lorenzoleb

        3 months after exposure or after pep completion ?
        My concern is that since the last week of pep till now (6 weeks) i am having muscle pains and joint pains and rash on my face that come and go. But no fever and no swollen glands. Do u think it could be ARS symptoms ?? And did u ever see someone testing negative 5 weeks post pep ( 9 weeks post exposure ) turning postive at week 12 ???

  17. hi doctor:
    my english is not good , sorry.

    I have Anal sex and I was a btm(he fuck me)

    after exposure
    I got pep(Truvada+Tivicay) (TWO hours after exposure)

    I wanna know which test should I choose when finishing pep(That is to say :after exposure 28 days)
    I wanna know YOUR Clinical Experience which test should i choose that is Indicative(almost conclusive) when just finishing pep

    thanks!!

  18. Hello Dr.

    I took pep following a condom break incident. I was the bottom and there was no ejaculation. Not sure if there was precum. I tested the day i finished PEP and it came back negative. Is this conclusive? or not a good indicator. If Pep had failed would it have been picked up at this point?

    Thanks

  19. This is a very good indication. Please repeat your test at 3 months for conclusive results.

  20. Dear Dr.

    I had vvaginal sex however the condom broke and I contracted clamydia. I Took PEP for 7 days after the 9th day of incident ( way too late), then i took a 4th gen hiv test at 21 days and 28 days. Are my result reliable, a good sign or considere conclusive? Please advise, thanks a lot for all your support.

    • It is essentially conclusive.

      • Have you ever heard of someone’s result changing after 28 days with 4th gen test if there was no further expoaure at all, keeping in mind i took PEP for 7 days. Thanks again for all the assistance Doctor.

      • Sorry to bothrr you again Dictor, but have you seen or heard of 4th generation test in a situation similar than mine turning positive after 28 days post exposure. Please advise, thank you.

  21. Memoirs13

    Hi Drs.
    I got a condom broke, me receptive anal no cum. I took PEP (Teevir) at 20 hrs and became adherent and finished for 28 days. But out of anxiety, i took an ECLIA 4th generation test on the 27th day (2 days before i finished PEP) post exposure and it is non-reactive. My questions:
    1. Is it already a good indication of my status?
    2. I wonder if I can take a test again with an ECLIA, at 6 weeks post exposure,can it be somehow conclusive?
    3. Is there any test which I can have for a shorter conclusive result instead of waiting for 3 months post exposure. I really want to move on with this.
    Thank you very much Drs.

    • The test is a very good indication (essentially conclusive). But officially we would still recommend a repeat test at 3 months post-exposure.

  22. Memoirs13

    I had a condom broke (me as as anal receptive, no cum) got PEP 20 hours after exposure and became adherent and finished 28 days. but out of anxiety, i got tested by ECLIA 4th generation test and it is non-reactive. Is it already a good indication? i was told to get a test at 3 months post exposure. Will it not change? If I take a test 8 weeks after exposure by ECLIA, can it be essentially conclusive? Or what test is better to get an earlier conclusive result instead of taking a test after 3 months? Thank you very much.

    • Your tests are a very good indication already. But for conclusive results we would recommend a repeat 4th gen combo test at 3 months.

  23. I took PEP after an oral exposure, with ejaculation, with a treated hiv positive person.

    Ive had red spots rash appear on my body during and after pep, and 3 weeks after pep I had a short 1 day flu-like illness, with body aches, nausea, vomiting, and a fever over 100.

    I’ve tested negative 3 months after my last pill, will I have to test at 6 months or later?

    • No, you do not need a re-test.

      • Actually they were UNtreated, and likely recently infected, with high VL.

        measles like rash. aches. fever over 100. vomiting.

        If it was due to HIV, is there any way the body fought off the HIV naturally? It seems more likely that the virus is replicating in lymph tissues and is not yet present in blood, thus undetectable, with a delayed viral rebound.

        Delayed seroconversion with PEP?

        • Your testing window is adequate. Your symptoms are not due to HIV. The risk from oral sex with an HIV positive person is still close to zero, and you completed PEP. Your body does not ‘fight off HIV naturally’ nor would it be present in lymphatic tissue – it is a blood-borne infection.

      • Dear Doctor,
        2 months ago i had sex with a girl i met, i did anal sex with a condom but was broken when i pulled it out.
        After 24 hours i took pep for 28 days, and did a 4 gen test after 3 weeks of being done with pep (7 weeks of exposure), it was negative, how accurate is this test? The clinic councelor told me i did not to test anymore because it was conclusive but i am still worry because i see different information online, thank you for taking your time to answer my questions.

        • The test is essentially conclusive, but officially PEP guidelines will recommend a repeat at 3 months.

          • Thanks for your response, I took a test at 9 weeks after exposure, (5 weeks after pep), because of being very anxious, it was negative, I know you recommend it at 12 weeks after exposure, have you ever seen someone changing to positive later?, thank you Dr.

  24. Dear Doctor,

    I had a protected sex with one guy However, he asked me to try a fake pussy, he put his penis in it one time and then I put it twice. At end, he did not cum. ( that guy is a nursing aide) but I’m still worried.

    I have consulted some people and started taking PEP. I’ve been very worried since then. its been only 10 days after the exposure but was told that PEP would effect PCR test if I did one.

    What are the actual chances of me getting HIV from this sexual event?
    Should I clam down?

    Thank you very much

    • Did you have sex or not? If yes, there is some risk. Protected is obviously much safer. Please speak to your doctor for proper risk assessment.

      • Yes, I topped him but with condom (I’m pretty sure the condom did not break)
        I’m worried about the fake pussy, He put his penis in one time and then I put it twice.

        Could you please tell me the risk and can I be tested for PCR during PEP?
        Thank you very much Dr.

  25. Hi, i tested negative at 9 weeks since possible exposure using the 4th generation test. I tested negative at 11 days using PCR RNA hiv test, also again negative at 5 weeks using 4th generation test (I was on truvada 2 weeks after exposure and only for 21 days which was at 4 weeks) and again negative at 6 weeks using PCR RNA hiv test. I have been diagnosed for herpes 1 and 2 as well as h. Pylori. I have a few small canker sores on the inside of my gum, small but swollen lymph nodes under both arms, a hard fixed one under my chin and matted inguinal nodes, lost 9lbs post possible exposure. I have had low grade fever for 6 weeks. Should I still test after 12 weeks and up to 6 months even though I only used Truvada for 21 days which was at 4 weeks post exposure?
    Could the Truvada have caused a false negative even at 9 weeks?
    It’s now 11 weeks and I feel small pebble-like posterior cervical nodes and one hard small fixed superior cervical node, could this be hiv ?
    Could hard fixed lymphadenopathy turn out to be nothing ?

    • I believe your HIV tests are conclusive. If you have lymphadenopathy or other symptoms, please get properly assessed by a doctor – you do not want to miss other potential conditions.

  26. Joe Blog

    I had kissed, open mouth deep, the massage lady at a spa while she was performing hand job. The doctor started PEP(Truvada) after about 80 hours. I stopped taking it after 5 days. I went for Alere combo(p24 for hiv-1 and hiv1/2 antibody) test(4’th gen) at 0+14 days and 0+28 days, both negative. Can I consider my test conclusive? Would Truvada affect my test result? Also I had my HBV vaccination(first shot within 20 hours of exposure) and second on 28’th day right after the HIV test.

    • Joe Blog

      Just to add the spa was in Bangkok and I don’t know status of the lady. Also I have not engaged in any other sexual activity post the episode mentioned above.

    • Your risk is zero to begin with. Therefore your results are conclusive.

      • Joe Blog

        Thanks a lot Dr. Jonathan, I wish I would have consulted you to begin with.

  27. Tyrese929

    Hi doctor I love the way you answer most questions everyone asks on here it’s really helpful and we all thank you.

    I had an exposure about a month ago and started pep about 7 hours after exposure and took it for about 4 days then stopped.

    14 days after exposure (about 10 days after taking pep) I got a 5th generation bio lab 2200 hiv test done and it came back negative, but I came back positive for chlymadia. Then 28 days after exposure (24-25 days after stopping pep) I took a 4th generation Alere determine hiv test and it came back negative (while still on chlymadia treatment)

    My questions is
    1. Can pep make my hiv tests negative if taken 25 days after stopping pep?
    2. Does the medicine for chlymadia make my test come out negative?
    3. By me being sick does that make my test come out negative since my body is producing antiboddies to fight my cold?

    • There is no very good data on the effect of short courses of PEP on seroconversion delay, but I believe that your test is essentially conclusive. I would still recommend a precautionary repeat test at 3 months post-exposure. The chlamydia/medications/flu illness does not affect the HIV test.

  28. Dear Doctor
    I had unprotected vaginal sex with an hiv+ man and I bleed and experienced pain when passing urine after sex.I started Pep 48 hours later.Im I safe from not getting infected with hiv

  29. Good day Dr…Pls am worried and terrified about my mistake…Had a vaginal sex with an HIV+ lady and my condom burst inside…I didn’t realize ontime till i ejaculate inside…Am a circumsized male and after 16hrs of my exposure i was given PEP which contain (TENOFOVIR, EVAFIRENZ AND EMTRICIBATINE)..I took the PEP for 30 days but i tested 25 days after my exposure while am still taking the PEP medication (THE TEST KIT USED WAS RAPID TEST KIT FOR HIV 1/2)..The test result was negative but the Dr said i should test again in 6 weeks time when i finish taking the PEP course, Pls Dr am i safe?..will taking PEP 16hrs after my exposure for 30 days help me?..Is my negative test at 25 days while still on PEP medication accurate? ..The testing kit used was the RAPID TEST KIT for HIV 1/2…pls am i still in danger or the test is negative?

  30. Post PEP Testing

    Hello Doctor,

    I took PEP (tenofovir lamivudine efavirenz) without missed dosage for 30 days due to a condom slippage accident… fast forward, I had a third generation Rapid ICT at 6 weeks post pep/10 and 2 days post exposure which turns out negative. My doctor told me to retake the test using fourth generation at 12 weeks post exposure.

    Q1: How likely will my negative result turn positive?
    Q2: If my 12 weeks post exposure 4th Gen test is negative, is that conclusive? Or do I need to take another test at 6 months post exposure?
    Q3: how effective is the PeP regimen given to me in your opinion?

  31. worriedsomeone

    i got exposed to a positive girl while i had hpv sores on my penis did that increase my risk. i was given lamuvudine, zidovudine and atazanavir as PEP after 42 hrs. will they work considering that i had sores on my penis during exposure time.also i developed rash an my hands and legs on the 11th day after exposure.

  32. Dear Drs,

    I had my last 4th generation test (ELISA + p24) 12 weeks after exposure, and some 7,5 weeks after finishing pep. It came back negative. Would you consider it conclusive or I need further testing? I had risky exposure (insertive anal with untreated HIV+ 3 months back) and no repeated exposures. I would like to continue with my life…

    Thanks!

    • I feel your tests are essentially conclusive, but with PEP guidelines will still officially recommend at repeat test at 3 months.

      • As I said, I had tested 12 weeks after exposure. Is not that the same as 3 months? Or I have to be tested 3 months after finishing my PEP? Sorry to bother.

        Thanks

  33. Hi Doctors,

    With your experience, have you seen or known any patients with 3 month or 6 month Oraquick negative, becoming positive after their tests? And how conclusive are these tests? Thank you.

  34. Worriedfrom Nepal

    Dear Sir,
    Thanking you for outstanding work you people are doing. I had following circumstances. Sorry for my poor English. I m Nepal, 28 male.
    Exposure: condom broke with CSW vaginal exposure for 4-5 minutes, noticed after ejaculation.
    Started PEP: TDF+3TC+LPV/r within 5 hours of exposure.
    Base Line Test: Rapid test negative,VDRL, TPHA Negative.
    5 weeks post exposure: Rapid test Negative.didnt known about 4th generation.
    Symptoms: extreme depression and fatigue.
    10 weeks post exposure: Same Rapid determine, Negative.
    Symptoms: 4 kg weight loss, tingling muscle sensation, on and off rashes everywhere.

    12 weeks post exposure: 4th generation Elisa Ag/ab negative. Value: 0.2495.
    Still fatigue, muscle pain around neck and arm pits. Sore throat
    15 weeks post exposure: VDRL, TPHA, 4th generation Elisa to ease my mind all Negative.
    Symptoms: still deep pain inside armpit. And sore throats come and go.
    Later doctor asked me to test Viral Hepatitis.
    17 weeks post exposure : Hbsag negative and HCV antibody test negative.
    19 weeks post exposure: 4th Generation Elisa, still Negative. I m still testing because still I have got symptoms but all test negative. I m marrying next month with my girl friend. I told her about the incident even she will marry me. I don’t want to hurt her in life time. I don’t know what should I do.Please I really seek expert advice if it doesn’t bothers you.

    • Worriedfrom Nepal

      Sorry I forgot I took complete course of PEP for 28 days.

    • Your tests are more than conclusive. You do not have HIV. Your symptoms can be caused by anxiety. If you are concerned, get them evaluated with a doctor for other causes. Again, HIV is conclusively out of the picture.

      • Worried from Nepal

        Thanking you doctor for the reply really lot of relief can’t imagine.I have pain on lymph nodes on neck from yesterday. Main concern is I didn’t did 4th generation immediately after completion of PEP neither 4 weeks post PEP which would miss detecting P24 antigen and my fourth generation after 12 week post exposure would only behave as 3rd generation Elisa. Here in Nepal only infected people can get viral load test. Sometime I think coming to Your clinic for test to rule out HIV. Right now. Because I want exactly what happened come up to this point 19 weeks after Exposure Negative and if turn out positive. No furture exposure, complete adherence with PEP. I will cent percent see you amazing people after my marriage. I m engineer I really have to know cause of late seroconversion if it happens after 19 weeks.
        Don’t want ruin my girlfriends life and her family.

      • Worried from Nepal

        Dear Sir,
        Thanking you for the reply. So much relief can’t imagine. I really want seeing you people go diagnosis. Here in Nepal Viral load test is only available for documented infected people. I have swollen lymph nodes below neck from day before yesterday. My girl friend don’t want me to do further test after 19 weeks Fourth generation Elisa. But can’t rule out still lymph nodes. I m an engineer and really want to know what’s going on after the episode and if late Sero conversion. I was stupid doing fourth generation directly on twelve weeks rather than earlier. It was unknown to me.
        Best Regards,

  35. Age:40, Gender: Male

    Hi,
    I had unprotected test 5weeks ago with sex worker , I mat doctor after and he suggested gualtive pcr hiv1 and p24 combo and hc and hb
    also all three result came bake negative.

    my question is after 5 week is both test are cinfrimativ or not becuase my doctor said you dont requiredw more test.

    but from 8week I am geeting some pimple on my arms and face is this is related to early hiv symptoms.

    Thanks,

    • I would say the HIV test is conclusive but Hepatitis B & C may take another 2 months to be fully conclusive. Your pimples are not due to HIV.

  36. aylliaute

    Hi dr, first thank you for for the time you spent to answer the questions in here.
    I’ve read your post and the comments carefully, and here is mine :

    Of course this is my understanding, an it might be false!
    It’s said that a test right after the completion of pep should already be a really indicative result, meaning pep isn’t delaying seroconversion.
    Anyway, if pep is somehow designed to supress the hiv virus in the blood, there should be no hiv in the blood and therefore no production of antibodies. And so (if infected) the production of the antibodies would start at the end of the pep-28 days, meaning a test right after the completion could really come negative although a seroconversion (AB production) is yet to come.

    Is this is true, how could a test right after completion be really indicative ?
    I’m just asking as I tested negative one day after finishing pep, but can’t determine how reassuring that result should be. In a few days I’ll do my ~20days post pep test

    Also a last thing, my exposure was receptive oral sex on a homosexual sexworker. It’s said that the risk is higher if it exists an other STD, but what’s the exact meaning of this? That if I was already infected with an other STD the risk is higher, or that if during the intercourse I’ve been contaminated with an STD then the risk of hiv transmission
    is higher?

    Two days after finishing pep an infection started in my throat, like a second uvula. Would that be possibly linked to an hiv infection? Or is there an std that could possibly give me that symptom?

    Thank you a lot and sorry of the long message, I’m looking forward to your opinion on thoses questions

    Best regards!

    • PEP does not delay seroconversion. You would still have HIV antibodies produced if you were infected. There have been no documented cases of a negative test after PEP turning positive later on if it was taken properly and there were no other high risk exposures during PEP. The guidelines for a repeat test 3 months post-exposure are precautionary. In any case, your initial exposure is close to zero risk.

  37. Steve S

    Would Atripla have same effect on window period as pep? Or would it be more likely to cause a delay in antibodies?

    If somebody took Atripla 4 weeks after exposure would it have any effect on antibodies production?

    • Steve S

      Sorry for asking again but my original questions disappeared and I though they got deleted somehow, didn’t mean to ask essentially the same question. Please respond I am going crazy, already lost my job and probably my wife over my anxiety.

      • Please see a psychiatrist. HIV is not the problem, only your anxiety.

        • Steve S

          I am seeing a psychiatrist, I want to put this behind me. I just can’t get over the positive p24 test. Also when this first happened my cd4/cd8 count was inverted, that was after 11 days on Atripla. I’ve read inverted cd4/cd8 is very unlikely outside of hiv.

    • Atripla does not affect the window period or antibody production.

  38. Steve S

    PLEASE HELP. I tested positive on p24 portion of a test. I was put on Atripla that day. On the 11th day after starting Atripla I was undertake. I stopped Atripla on 18th day dr said it was false positive. Since then I have taken many test all negative or undetectable. My last viral load test was 7 1/2 months after stopping Atripla. My last antibody test was 8 months and 3 weeks after stopping Atripla. My risks was 4-6 weeks prior to testing positive. Also had a risk approx 15 years ago. Multiple Drs have told me I’m negative but I am still scared. Could the Atripla have made me undetectable and could it have delayed my anitivody response? Could I have no antibodies because I’ve been infected for 15 years? Please help I want to move on from this nightmare.

    I was given a confirmation test but dr admitted they gave me an antibody only and by the time they realized their mistake I was already on Atripla for 11 days.

    • Steve S

      PS – my exposure 4-6 weeks prior to testing positive was getting blood on my hand at work. I had a non bleeding cut on my hand at the time. I didn’t think any blood got onto my cut but now I have doubt. I’ve only had one sexual partner during the last 15 years and she tested negative. I am worried that maybe she is negative because she got it from me early in our relationship and no longer has antibodies. I’ve been to 3 doctors and all refuse to test me any more. My question is how can they be so sure given I was on medication.

      During this time I’ve lost a lot of weight and have a white coating on my tongue that looks like thrush. Drs think my anxiety is causing my physical symptoms.

    • You should listen to your doctors as they are the ones who have performed your tests and know your clinical situation. Overall what we can say is that false positive results happen. With multiple negative results thereafter, by definition you do not have HIV.

  39. Dear Dr. Tan,

    I completed 30 days of PEP prescribed at your clinic, did an Elisa ag/ac duo combo test 4 months after exposure, 3 months after treatment. It came back negative. Is it conclusive? Can I move with my life?.

    Thank you so much

  40. Philospher

    Dear doctors,

    That’s my situation: receptive anal intercourse after a condom broke. The Partner of unknown serostatus refused to test.
    I went to the hospital the day after.
    1) 4th generation test at baseline Negative.
    Local hospital prescribed PEP after 24 hours. I went on for 28 days.
    2) 32 days after exposure (4 days after PEP), 4th generation test Negative.
    After sore throat I did another test:
    3) 25 days after PEP, 4th generation test Negative.
    Would you consider these quite conclusive? I know that 3 months post exposure will be conclusive, but I’d like to ask you an opinion.
    Many thanks

  41. Dear Sir,
    I tested after Eight week post PEP with fourth generation Elisa,Negative.
    But results was published within 6 hours after blood was taken. Equipment they used was Bio Rad genscreen ultra ag/ab. But here somewhere in Internet found it will take seven days for result to come with fourth generation elisa. Shall I be assured the test they took was fourth generation. I also asked them they said it’s 100 percent fourth generation.time does not matter for test to come???

    • I cannot tell you what test the lab did. There is no way for me to know. 4th Gen tests can be done in as little as 20 minutes.

      • Dear Sir,
        Lot of thankful appreciation for the reply. I just need your words to move on. I did fourth generation Elisa Ag/ab after exactly 12 week of exposure, 8 weeks of PEP, negative but before this mark only rapid tests all negative. Lot of weight loss and fatigue during this period. I have followed all your recommendations for testing and PEP but due to lack of knowledge I did all rapid test before final test on 12 week mark. I m so much stressed. Just a words sir..!!

  42. Lucas_H

    Hi Doctors

    I will keep it short and simple or try’s to not to waste your time. I had an exposure with a HIV+ person 18 days ago. I was given PEP two days later and have been taking it since. I went for a HIV PCR Qualitative test (it was the DNA version) on day 15,5 after the incident. The result came back today as negative. 24 hours after giving my blood to the blood bank for the test, I started having symptoms such as sore throat and enlarged shotty lymph nodes in my groin area. My doctor diagnosed me with upper respiratory tract infection and I now am taking antibiotics for. He wasn’t too well informed on the testing about my question and that is why I come here for your thoughts as experts in the field. Is it possible that I could be seroncoverting right now and the DNA PCR test missed it as it was negative? My personal thoughts are if I was seroconverting or started just 24 hours after I gave blood for the 15,5 day DNA PCR test, it should have picked up as positive right? What are your thoughts? Just to confirm again, I’m still on PEP. Thanks you doctors kindly.

    • If you are having symptoms due to ARS then presumably your test would be able to detect HIV. But as a general guide I do not really recommend PCR testing while a patient is on PEP, as you are essentially taking antivirals which will suppress viral load. It is a better indication if you do a 4th gen combo Ag/Ab test – these will be positive if symptoms are due to HIV. In any case, I do not think you are seroconverting. A recent study showed only 1 PEP failure out of close to 3700 cases.

  43. Hi Dr. I just read the comment you left to the previous individual and you said that he needed a test 3 months post PEP is it it 3 months post exposure or 3 months post PEP?

    • Different countries/organizations have different guidelines. I am happy with my patients repeating the test at 3 months post-exposure.

  44. Herman

    hi doc
    am a new graduate physician assistant but blood splashed in my eye when I was suturing an accident case,a few minutes the nurse wiped me of with an antiseptic and tested the guy was positive but (he didn’t know) .actually after around 30minutes I ran water in my eye and began PEP after 5hours. on my 14th day I did determine alere negative statpak repeatedly reactive a few days later did uni-gold negative but still stat pak reactive. And still on the same day (14th day taking pep) i sent my blood for pcr though am waiting for the results. please some word am worried

    • Are all 3 tests you are taking antibody-only? If so, they would not be a very good indication of your status given the early window period. Although a PCR test is a good indication now, there is some data to show reduction in sensitivity when you are on PEP (as they are antivirals and will suppress viral load). Best thing is to complete your PEP and do a 4th generation Ag/Ab combo test thereafter, with a repeat test at 3 months for completion.

  45. Martin90

    hi there docs

    i have a question for pep. i started it 60 hours post exposure with viraday. stupidly my exposure was unprotected receptive anal intrcourse with a recently infected hiv poz prostitute who is not taking medications.

    what is the likelihood of it working???
    have you seen ANY pep failures between 48 to 72 hours???
    is viraday a good pep regiman???

    I am losing my mind with worry. pls advice!! Tnx

    • Viraday is fine for PEP. I have not personally had any PEP failures if taken properly and with no further risky exposure while on the medication. PEP will essentially reduce your risk of HIV transmission by up to 50x.

      • Martin90

        Tnx you Doc. Just one question, even if I started it at 60 hours??? Would you consider this late???

  46. Gopal62

    Dear Sir,

    Thanking you for doing great job here. Please go through the sequences I have been through:

    I m 27 years male, Heterosexual
    Exposure: Condom breakage, Single 3-4 minutes exposure CSW, noticed after ejaculation.

    PEP: Luckily started taking TDF+3TC+ LPV/r within 4 hours of exposure. Complete adherence up to 28 days strictly.

    Side effect: felt fatigue moderate and some time loss of appetite.

    Physical changes: 3 kg weight loss, on and off one or two rashes sometimes, running nose 4 days. After PEP. No fever.
    Emotional changes: so much stressed and anxiety, sometimes suicidal ideation.

    Tests: 1) Baseline:Rapid HIV 1&2 negative, determine negative, Tpha negative, VDRL negative.
    2)5 week post exposure, 1 week post PEP:Rapid HIV 1&2 negative, determine negative I think Rapid is tridot kit.
    3) 10 week post exposure, 6 weeks post PEP : Rapid HIV 1&2 negative , determine negative, same test as previous.
    4) 12 week post exposure, 8 weeks post PEP:
    Fourth generation Elisa, HIV 1& 2 Ag / Ab screening test negative.

    I m regretting that I should have done previous tests with fourth generation on first week and six weeks post PEP rather than doing now on 12 weeks post exposure. I have searched a lot of things and cannot find if 4th generation test is same effective doing on 12 weeks as immediately after PEP.

    Please help me doctor with the query. Had followed all your recommendations for testing and PEP but thought all the testing I was doing latest fourth generation previously.
    Best blog for People with PEP at present. I want to move on thinking it’s conclusive now. Your single words would be decision for me.

    Thank You.

    • You do not have HIV, your tests are conclusive at this point. You can move on with your life.

      • Gopal62

        Much appreciated with prompt reply. Certainly I will move on. Just only a query .Is doing fourth generation Elisa effective 12 weeks post exposure, 8 weeks post PEP rather than doing previously on a week or 6 week post PEP.

        • 12 weeks post-exposure is fine.

          • Gopal 62

            Dear Sir,

            On my 4th generation Bio Rad Genscreen a ultra Ag-Ab on 8 week post exposure,
            OD value: 0.0620
            Ratio: 0.2490 but result was negative. Is it close to cut off value?? Will it reach cut off value with time. I was on PEP after vaginal exposure within 4 hours. Truvada and kaletra. Also lowest OD value tested today was 0.470 and ratio: 0.1888.
            Mine was near highest among all.
            Do PEP effect OD to reach Cut Off????

            From now on never disturb ???

            Thank you.

          • Your test is negative. We do not look at the level of the value. It is essentially conclusive at this point, but we still recommend a repeat test at 3 months post-exposure as per PEP guidelines.

  47. sandep

    Dear Dr.,
    i want to know that after insertive anal exposure i take pcr rna and elisa test at 17 th day after pep completed. and i also inform you that i take pep at 96 hours can you see any case which can turn positive after this test my both test are negative. and what are the chances of me in safe side please comment

    • Your tests are essentially conclusive, you do not have HIV. A repeat test at 3 months is still recommended post-PEP as a largely precautionary measure. PEP studies have only shown significant efficacy up to 72 hours post-exposure. So it is likely you would not have been infected even if you did not take the PEP.

      • sandeep

        Thanks Dr. Jonathan
        sorry doctor but after exosure i know that he was HIV positive. and i take PCR RNA for HiV 1
        please comment can we take elisa test at 28 th day after completed pep. i taken elisa test 4 the generation ?

        please comment i reply because monday is my 28 th day after completed pep.I listen that HIV2 is less reactive.
        and if i take PCR RNA for HIV at 28 th day after completed PEP it may be conclusive.
        because i want to clear and move in my life .
        Thanks

        • I would recommend the 4th generation combo test once you complete your PEP, and a repeat test (can be 3rd generation) 3 months post-exposure to complete testing.

          • kkkkkk

            HI, Dr. I really appreciate you for your this work you are really great.
            After insertive anal exposure with HIV + Person. I take duo test at 37 day after PEP and 72 day after exposure all are negative. I read US CDC PEP of guidelines 2016 in which he consider conclusive test at 3 month after exposure if person is not expose to Hepatits C. I check my hepatitus B & C at approx 49 day they are negative I know they are conclusive after 3 month. I read also he suggested regimen which cannot i take. i take different regimen it is
            1. Tenofovir Disoproxil Fumerate and Emtricitabine Tablet
            2. Lopinavire and Rionavir Tablets
            at near 95 hours after exposure.
            I know i take late it may be work or not

            AT last I know only one thing can i consider my test conclusive after 12 week exposure if iam not exposure to hepatitus C or 90 day after exposure or 90 day after PEP.

            Sorry for asking many question
            Please reply I wait
            Please suggest

          • I believe your tests are conclusive and you do not require any further testing.

  48. TuckerD55

    Hi Dr. Tan & Partners

    I had an exposure via receptive anal sex 12 days ago and have begun taking Atripla PEP after +-55 hours. I have three questions for you doctors.

    1) I’ve read your posts that it’s not too late and still efficient but from previous patients, have any taken PEP at this time and ended up seroconverting?

    2) What are the chances that it will work? Out of 1 to 10 with 10 being 100%?

    3) I plan to take a DNA PCR at 16 days post exposure although will still be on the Atripla PEP (I will be 15 tablets in). I have read that the RNA PCR is not recommended as it’s a viral load test however with the DNA will it give me a good indication of my status as it will look at the actual DNA in my blood?

    Please could you give me your professional outlook on this. Thank you sirs.

    • Hi, I personally have not encountered any PEP failures if taken properly. The chances of PEP failure are much less than 1/10 if taken properly and there are no further high risk exposures in between – this is when used for a known HIV+ exposure. There is no real need to do the DNA or RNA test midway through your PEP in my professional opinion. Just complete your PEP regimen and get tested with a 4th gen Ag/Ab combo test thereafter. You will be fine.

      • TuckerD55

        Thank you for the speedy reply Dr. Jonathan. Your response has lifted a lot of the worry I have which I say thank you for. I was however not clear in my first message to have outlined that the exposure was in fact with a HIV+ person who did not know that they were HIV+ so an extremely large viral load is expected.

        Three final questions which I would extremely appreciate your response – please could you answer them, please:

        1) With the fact that there are no further risky acts after administering the PEP. When you say you have not seen any PEP failures when taken properly, do you mean with good adherence or taken before the 72 hours cut off time limit? I ask as I am worried that +-55 hours is too late to have caught it.

        2) About that DNA PCR, if I were to take it at Day 16, in terms of a percentage how accurate would it be in your professsional opinion?

        3) When I take the 4th Generation DUO test at Day 31 which is the day after I complete the Atripla PEP course (30 tablets), how accurate will be the result?

        Thank you Dr!!!

        • Taking PEP properly means a) starting within 72 hours, and b) not missing doses for the entire course. There is some data to suggest DNA PCR may not be as accurate when a person is on PEP as essentially they would be taking antivirals targeted at reducing viral load. It will probably serve as a good indication, but it is not conclusive. If you take a 4th gen duo test after PEP, you result will be essentially conclusive. We would then recommend a repeat test at 3 months post-exposure largely out of precaution. There have been no validated cases of a negative 4th gen test post-PEP turning positive 3 months later.

          • TuckerD55

            Thank you again for the fast reply. Really from the bottom of my heart, thank you. You have offered your fast and knowledgeable advice without hestitation which impacts people’s lives in the most comforting way possible, case and point, yours truly.

            I will come back to this forum should I have any queries before the time PEP is over (I am however hoping this is not the case) although I will undoubtedly come back to tell you when I have tested with the DUO after PEP.

            All the best Dr!!
            May the force be with you.

  49. 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.

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