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SECOND EXPOSURE WHILE ON PEP

Question: 

i recently got into a relationship with a lady i did not know of her HIV status. we eventually had an vaginal sex (with no condom). i was very worried though she told me not to that she was sure that she is negative. but out of fear, i went to my clinic and i was given PEP treatment at about 40 hrs post exposure.
the relationship continued and we had another sex 6 days after i started PEP. i was not a brief sex at all and i ended up having some injury on my penis as a result of the activity.
I almost discontinued the PEP, but asked her to just do the HIV test, and it came out positive. i was shocked!!!!!
i have not had any rashes, fever, sore throat and all that except jaundice, nausea and severe weakness once i take the drug.
i experienced an unexplained burning sensation,needle like pricks and colicky pain in and on my penis and my scrotum. sometimes i feel like something wants to come out but nothing comes out of my penis. this started about two weeks after exposure. but no discharge nor sore nor rash around my perineum nor inguinal area.
all STI screening i did were negative and i had to take treatment for STI just in case ( this was my decision).
i have completed my pep and got tested again at day 33 post exposure and day 30 on pep and im still negative.
i was placed on LAMIVUDINE AND TENOFOVIR + ATAZANAVIR AND RITONAVIR.
my questions are
1) will my second exposure limit the efficacy of PEP?
2) should i have extended my PEP to 6 more days.?
3) are those symptoms i had possibly due to seroconversion?
4) is my current negative result encouraging?
thanks a lot for your anticipated prompt response. i am honestly scared.

also, i just got an antibody test approximately 2 months post pep and 3 months post exposure. it came negative. i don not know what to make out of this as my symptoms still persist. my palms and sore of my feet are peeling of now. my bones ache and i am tired like my soul is out of my body. i need help please

Answer: 

Hello there,

Thank you for your inquiry. From what we gather from the question, you were asking about the limitations regarding your use of PEP following your second exposure, the meaning of your symptoms, and the conclusiveness of your negative test results, 3 months post exposure.

Please consider the following information about PEP and additional exposures:

PEP is very effective but will not prevent 100% of HIV transmissions from occurring. It must be started within 72 hours of exposure to HIV. For PEP to be effective, a person must have high adherence to the full course of PEP drugs and should have no further exposures to HIV while taking PEP (1). PEP is most effective when used diligently and without any additional exposures. Any additional high-risk exposure may make you more susceptible to HIV acquisition while on PEP. In this case, extending PEP treatment may not provide any further protection from HIV acquisition if you have encountered another high-risk exposure. For the future, PrEP (Pre-Exposure Prophylaxis) is considered a powerful HIV prevention tool and can be combined with condoms and other prevention methods to greatly reduce your risk of HIV acquisition (2).

It is important to acknowledge that it is nearly impossible to attribute any/all of your symptoms to HIV acquisition without confirmation through HIV testing methods. HIV presents itself in many different forms in each individual case, and can have a different timeline in each individual.

In regard to your negative test results 2 months post PEP and 3 months post exposure, there may be factors that may conflate with the conclusiveness of your testing. Concurrent use of PrEP or PEP may reduce accuracy of results if the test was taken during the use of your PEP (3). However, depending on which HIV testing method you received, your negative results may be considered conclusive at 3 months post exposure. For example, the 4th Generation EIA test can be considered completely conclusive at 12 weeks post exposure (4).

Recommendation: If you are continuously engaging in high risk activity, PrEP may help lower your risk of acquiring HIV if used as directed. Further, there does not appear to be the need for further HIV testing with the scenario provided, please refer to a physician for other health related questions.

All the best, AIDS Vancouver Helpline/Online, Cody