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Condom broke during anal, put on PEP, ARS symptoms?

Question: 

Dear AIDS Vancouver,

Thank you very much for all your help and for replying to all the questions.

I am a 29 year old gay male, and I had sex on the 26th of October, where I was the insertive partner. However, the condom broke just at the beginning, and I have noticed it only 30 seconds after it broke, after which I have pulled out (I am also circumcised). The next day (29hrs later) I went to the hospital and got PEP. Immediately after starting taking PEP, I got a red sun-burn-like rash under my armpit and belly and legs, and I went back to the hospital and they replaced the regimen Ive got with Descovy and Rezolsta that I am using now. I know it couldnt have been ARS as it was a day after exposure.

Later on around the 6th day I got a slight cold and fever, which disappeared quickly.

On the 10/11th day I developed a maculopapular rash all over my shuoulders, neck, a bit on my back and chest, it was horrible, amd a fever. I went back to the hospital on the 11th day and they did an RNA test which came back negative.As soon as I got the results my rash and my fever disappeared.

On the 15th day I started getting chills and a fever all of a sudden in the evening (38,8), which subsided the next morning, but I started sweating all the time, especially in the evenings, I am having nightsweats for 2 days now.

I am on the 17th day now post exposure and PEP, and I am terrified.

Can you please tell me how big was my risk to start with, if the guy was positive? Could all of these be ARS? And could the RNA test taken 11 days post exposure be a false negative due to the PEP medication I was taking (because I have read somewhere online from some doctors who have been replying to others, that PEP can cause a false negative RNA?). But then again, can one have ARS symptoms if the viral load is undetectable?

Many many thanks!

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about the risk of acquiring HIV after having anal sex with a condom that ended up breaking. From the information given, this scenario is determined to be High Risk (Evidence of transmission through these activities and is the majority of cases of transmission).

The scenario mentioned above does meet the three components of the Transmission Equation. PEP (Post-Exposure Prophylaxis) is very effective at preventing HIV transmission if started within 72 hours after a high risk activity (1). It is important to note that the sooner PEP is initiated, the better, and that in order for PEP to be effective you must take all of the prescribed medication (2). HIV tests conducted while taking PEP may result in false negatives because an HIV infection may be present, but the drugs are suppressing HIV replication as well as the production of antibodies to HIV. Guidelines suggest testing with an HIV Antigen/Antibody test 3 and 6 weeks after the end of PEP as well as 3 months after PEP for completely conclusive results (3).

In regards to the symptoms you have been experiencing there are numerous explanations. They could all be attributed to the stress you are experiencing from this experience or even potential side effects from the PEP drugs (regardless you should continue taking PEP exactly as prescribed). It is unlikely that these initial symptoms are due to Acute Retroviral Syndrome (ARS) as these symptoms typically do not occur before 2 weeks after exposure.

Recommendation: Refer to Physician for HIV test 3 weeks after end of PEP.

Regards,

AIDS Vancouver Helpline/Online, Marie