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Testing while on PEP

Question: 

Hello,

I had a sexual encounter with an HIV+ man (which I found out later). Though I was the top and we had protected sex most of the time. I rubbed my penis on his anus and teased it, and inserted it into his anus for around 10 seconds a couple of times. I also fingered his anus and went in a bit deep with a couple of fingers. I had Dyshidrotic Eczema (very small stress bumps filled with transparent fluids but no open wounds that I can recall) on my fingers at the time.
I was put on PEP on the 60th hour post exposure and have been taking the medications everyday. I'm on day 14 at the moment and have 14 more to go.
On the 11th day post exposure, I started having a sore throat, a fever of 99.8 to 100 F, congested/runny nose, sneezes, coughs and headaches. Today, these subsided minus the fever which still fluctuates between 99.5 and 100 F.
I'm really worried about my HIV status. My question is: are there any sorts of HIV tests that I can take while being on PEP that can tell me about my status? Or do I need to finish all 28-days of PEP to get tested via 4th gen HIV test or RNA test?

Thank you for your help.

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about the availability and accuracy of HIV testing while taking post-exposure prophylaxis (PEP).

Firstly, I want to commend you on accessing PEP after engaging in unprotected sexual intercourse, which is a High Risk activity. PEP is very effective at preventing HIV if taken daily within 72 hours of an exposure (the earlier the better) for a total of 28 days (1). In terms of testing, for completely conclusive results from an HIV antibody test, you must wait until you have taken all of the prescribed PEP as well as an additional 12 weeks after finishing the medication. HIV testing while receiving PEP may not be accurate. If PEP was initiated too late or was not taken as prescribed, the HIV virus may have the opportunity to infect some of the cells in your body. If some of your cells are infected with the HIV virus, the drugs in PEP would reduce the spread of the virus so much that it may not produce enough antigens or antibodies to be detectable by an HIV test, resulting in a negative test. After the full 28 days of PEP have been taken, the window period for the HIV tests begins. If the 4th Generation antibody/antigen (Ab/Ag) test is available in your region, you can request this test 6 weeks after finishing PEP. Most HIV specialists consider this test conclusive 6 weeks post-exposure, but some guidelines do recommend another test 12 weeks post-exposure (2).

In the future, if you think that you may encounter more high risk exposures, you can consider using pre-exposure prophylaxis (PrEP) to prevent the acquisition of HIV.

Recommendation: Refer to a physician for an HIV test 3 months after PEP completion for completely conclusive results.

Regards,

AIDS Vancouver Helpline/Online, Marie