Follow up on precum exposure

[mrpdx]

I posted a question before, and may have made a mistake in not following the advice I was given here.  I had a single sexual encounter with a partner who is HIV positive.  He is on viral meds, and has an undetectable viral load (just reaffirmed yesterday).  we used a condom, but the condom broke during - we realized a minute or so in, and stopped.  he did not ejaculate and does not typically have precum (according to him).  I asked the question a few days after and one of your docs advised pep.  I asked several local doctors here (state / local hotlines), and they were torn on whether pep was even neccessary - one explained that it could do damage to my liver.  I ultimately decided not to do it.  Now (about a week later), I have experienced some symptoms that are scaring me a bit.  no fever to speak of (99 for about 12 hours), but I had diarrhea for about 24 hours, my skin felt pretty flush all day yesterday, and i've been exhausted.  Admittedly this could all be anxiety (or that McRib I ate on Sunday).  the diarrhea seems to have subsided, but I'm still quite tired.  If I think about it, i might find little aches and pains in my muscles - but I doubt that's anything.  I know you all have said numerous times that sypmtoms of seroconversion cannot diagnose HIV - but given my facts and circumstances, should I be worried?  is there a point where I should go and see an infectious disease specialist?  thanks again for any help.

[Edward W Hook, MD]

Welcome to the Forum.  I agree with the advice that you received on the International Forum and would have suggested PEP as well even though your risk of infection is low.  Your risk of acquiring HIV is rather low even with your condom breakage.  The likelihood of HIV transmission occurring on exposure to an infected sex partner is roughly proportional to the viral load of the infected person and if your partner's therapy is effective his viral load should be very, very low.  Also supporting this recommendation is a recent study that shows that when a partner is taking anti-HIV therapy a person’s risk of getting HIV is reduced by 95%.  BUT, 95% is not 100% (which is what a condom provides) and for that reason I would have encouraged you to take the PEP.  

At this time, there is no role for PEP since PEP is effective only if taken within 72 hours of an exposure.

As for your symptoms, they are most probably to related to HIV but, in your situation, it is probably worthwhile seeing your doctor and getting a viral load/PCR test to be sure that it is not. The reason for testing at this time is that there is some evidence that if your symptoms are due to HIV, starting therapy at this time would be beneficial. thus while I believe that this is unlikely to represent the ARS, you are one of the VERY few patients for whom having a PCR test at this time makes sense.  EWH

[mrpdx]

I followed your advice this time, and got a RNA PCR which came back >48, negative.  I assume that's a good sign at this point.  I have continued to have symptoms which could either be described on the Internet as seroconversion, or by my doctor as anxiety.  I suppose I should assume the latter at this point?  Thank you for the help.

[mrpdx]

Sorry - that should have read <48

[mrpdx]

I was asked to keep this question on this thread (I thought maybe I should pay again rather than continuing this thread - apologies).

just a little more detail than I posted above:

exactly 7 days in I experienced a sudden onset of diarrhea (lasted 24-36 hours), maybe the slightest low-grade fever (although I dont think it was ever over 99), my skin felt pretty flush (24 hours), and I was very exhausted (72 hours).  All I have now is a minor sore throat (the front of my neck really) - but I'm feeling much better otherwise.  On day 11 I took Dr Hook's advice and went to my primary to get an RNA PCR - he did that, an antibody, and a bunch of other std panels to be careful.  All the tests just came back negative - the RNA PCR showed <48.  My primary is up on the procedures, but he's not an expert in this stuff like you guys are.  So my question is - is the timing for my PCR test right / too soon?  should I be reassured at the outcome, or should I have waited another week or two to take it?  Obviously I will still be following up with my antibody tests at 4 and 6 weeks.

[Edward W Hook, MD]

If youyr symptpoms had been due to HIV, your PCR test would have been positve at the time you took it. Thus you can be confident that your symptoms are due to something other than HIV.  As you mention, you will still need antibody testing in the future. EWH

[mrpdx]

Ok - so my 4 week antibody test was negative, and my doctor did another RNA PCR and antibody test at 6 weeks, both of which were also negative.  In my case, should I still test at 90 days?  Am I mostly in the clear?  thanks Doc.

[Edward W Hook, MD]

Last answer.  Yes, you are in the clear.  

That will be all for this thread.  EWH