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Wrong PEP usage

Question: 

Hi
I know it’s stupid but due to lack of knowledge I started taking PEP 3 WEEKS(not days) post exposure and once I considered what I’ve done, I made my second mistake, I continued it for more than 2 MONTHS!

Now 7 months pasts from the day 0 and I’m totally frustrated..
I’ve tested regularly through this time, monthly NAAT and DUO tests.

I guess I can not consider my HIV status because the PEP has suppressed the viral load and the immune system had enough time to develope few amount of antibodies as an answer to low viral load. And due to presence of antibody the virus never had a chance to rebound. Probably that’s why both RNA and antibody levels are below the detection line.

What you may recommend?
Thank you

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about the effect of incorrect PEP usage on HIV viral load and antibody production.

First, let's consider what the HIV virus does in people living with HIV. The HIV virus hides in cells, known as the latent HIV reservoir, and is not able to replicate when HIV medication is taken and is effective (1). People living with HIV need to continuously take anti-HIV medication every day. If they stopped, their viral load would eventually increase because the antibodies that they have against HIV are not sufficient to stop the virus that was hiding in the cells from replicating.

You can apply this knowledge to the use of PEP. If you are infected with the HIV virus and take PEP within 72 hours, the drugs could potentially eliminate all the virus that got into your body before it infects your cells and finds a place to hide. If you take PEP outside of the recommended timeline, i.e. 3 weeks post-exposure in your case, it would not be able to prevent the early on HIV infection of your cells. This is why accessing PEP as soon as possible after an exposure is of extreme importance. It is recommended to take PEP everyday for 28 days after a risky exposure (2). Continuing PEP for longer than 28 days is not required or recommended , as it would not make you more or less likely to develop HIV.

According to your timeline, you are 7 months post-exposure and have received monthly NAAT (to detect the HIV viral load) and DUO tests (to detect both the p24 HIV antigen and antibodies against HIV). Since you did not include specific information on the dates or results of your tests I will provide timelines in which the result of a NAAT or DUO test would be considered conclusive:

  1. The HIV NAAT test can accurately detect infection 1-2 weeks after an exposure (3).
  2. Any tests conducted while you were on PEP would not be considered conclusive since the drugs could prevent HIV replication as you mentioned.
  3. After PEP is completed the window period for the tests is re-started. The DUO test would be considered conclusive by most HIV specialists 6 weeks after PEP is completed (3). Some other physicians and HIV guidelines recommend re-testing after 3 months for completely conclusive results.

Window Period

Recommendation: If you have received a DUO test outside of the window period after PEP (3 months post-PEP) then your results are completely conclusive. Refer to a physician for more personalized answers.

Regards,

AIDS Vancouver Helpline/Online, Marie