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Post PEP testing and symptoms questions, please help

Question: 

Hi, I had anal sex with the same guy for three times (I was top) differently in March 16th,18th and April 16th. The first one was unprotected, and the other two were with condom. At March 19th, around 62 hours since the first exposure I was placed on pep with genvoya.
I finished 30 days pep course, and tested negative one day after pep with 4th generation ag/ab test. But lots of symptoms came to me about one or two weeks after the pep like pain throat, headache, rash, night sweating, diarrhea, myalgia, arthralgia etc.. put me in super stressed situation. Did another 4th generation test at May 12th negative, at May 28th, a local doc recommended me to do 4th generation tests along with hiv DNA (copies/1E6 cells, lower limit 20) and RNA (20 IU/mL) testss because he said results can be conclusive results so I don't have to wait in anxiety any longer, the ag/ab test was negative, the other two both results came back with results not detected.
I thought I could be relieved then. But I didn't, some of the symptoms keeps bothering me even till today, makes my life a mess, can't live and work normally. I went to different docs asking for help and the did give me, but not working. New health issues keep appearing, one after another, I barely got sick before this whole thing. My latest tests were June 21st and July 19th. Both 4th generation tests and both negative.
Also one thing I want to mention is the index value of the last three 4th tests results are increasing from originally 0.18 to the highest 0.48. I asked and people told me it's normal as long as it's lower than 1, don't need to worry, is that right. Will it keep increasing with the time going by? Is my latest test conclusive that I'm not infected or in another words, do all of my tests show that I'm not infected. Do I need to test anymore? Cuz i read online that people taking pep may need as long as 6 months or even a year to get a conclusive result, Is that right? And why am I keeping having these symptoms that seem can't be treated, because all the medicine I'm taking seem not working at all. I'm so confused and stressed. Please help me with my questions.
Thanks for reading and answering in your busy schedule, and sorry for writing so long.

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about the conclusiveness of your negative HIV tests post-PEP, in which you began taking after engaging in unprotected anal sex. 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. It was very responsible of you to seek out PEP and HIV testing after engaging in a high risk activity such as unprotected anal sex. Starting PEP as soon as possible (within 72 hours) and adhering to the full course of the prescription will greatly reduce the risk of acquiring HIV by more than 80% (1). Based on the timeline you described, you finished your PEP regimen around April 15th-17th. Any 4th generation HIV testing that you accessed 6 weeks after that date are considered conclusive by most HIV specialists (2). This means that the 4th generation tests conducted on May 28th, June 21st, and July 19th are conclusive. Some physicians and guidelines recommend re-testing 3 months (12 weeks) post-PEP for completely conclusive results; therefore, the negative result from the test conducted on July 19th can be considered completely conclusive.

Briefly in regards to your other questions, as long as the index value of the test is below 1, the result is accurate. If the result is closer to 1, generally above 0.9, the laboratory will likely run the test again or request another sample to re-test. Also, with your negative results in mind, the symptoms you described are very likely not attributed to an active HIV infection. The physical effects of stress on the body are very real and could be attributed to some of the symptoms you described. I hope this response clarifies any uncertainty you had about your testing and helps ease your worries. If you decide to engage in risky activities in the future, consider always using a condom and potentially seeking out PrEP to further reduce the risk of acquiring HIV.

Recommendation: No need for further testing since testing with a negative result has been accessed outside of the window period. Refer to a physician for other health related questions.

Regards,

AIDS Vancouver Helpline/Online, Marie