Thank you for your inquiry. From what we gather from the question, you were asking about the risk of transmitting HIV through unprotected vaginal intercourse while on post-exposure prophylaxis (PEP), which was accessed after engaging in protected vaginal intercourse. From the information given, this scenario is determined to be High Risk (there is evidence of transmission through these activities and are the majority of cases of transmission).
Please note that the risk assessments we provide are solely based off of the activities that you have engaged in and not other potential contributing factors, such as PrEP or PEP use. Thus, engaging in unprotected insertive sex does meet the three components of the transmission equation. Further, protected insertive sex could also meet the three components of the transmission equation due to improper use or breakage of the condom. There are a few factors to consider in this question that lower the risk of you acquiring and/or transmitting HIV. Firstly, accessing PEP within 72 hours of a High, Low or Negligible Risk exposure and taking the prescription consistently and correctly is a great way to lower your risk of acquiring HIV (1). PEP contains the same drugs that people living with HIV take daily to suppress their viral load to a point in which it is not longer detectable. According to the results of the PARTNER studies, a person living with HIV who has a undetectable viral load is not able to transmit the HIV virus through sexual intercourse (2).
Additionally, since you tested negative for HIV outside of the window period, you are not able to transmit HIV to anyone since you do not have the virus.
With all of this in mind, it is very unlikely that you could have transmitted HIV to your wife through unprotected sex, since you received a negative HIV test 4 months post-exposure (approximately 3 months post-PEP, which is outside of the window period).
In the future, it is very important to refrain from engaging in sexual activity if you are uncertain about your HIV status. During the period of taking PEP, as well as the testing window period afterwards, refraining from risky activities will ensure you do not unknowingly transmit HIV. Accessing an HIV test at least once a year is important for all sexually active people to maintain good sexual health (3).
Recommendation: No further testing is required since you have already accessed an HIV test outside of the window period. Refer to a healthcare professional for other health related questions.
AIDS Vancouver Helpline/Online, Marie
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1) Post-Exposure Prophylaxis
2) PARTNER Studies