PEP & Delayed Seroconversion

[worried_goose]

I was reading the PEP guidelines published by the CDC (link: https://stacks.cdc.gov/view/cdc/38856)
and the following was mentioned:
"Persons who engage in behaviors that result in frequent, recurrent exposures that would require sequential or near-continuous courses of nPEP should be offered PrEP11 at the conclusion of their 28-day nPEP medicationcourse. Because no evidence exists that prophylactic antiretroviral use delays seroconversion and nPEP is highly effective when taken as prescribed, a gap is unnecessary between ending nPEP and beginning PrEP. Upon documenting HIV-negative status, preferably by using an Ag/Ab test, daily use of the fixed dose combination of TDF (300mg) and FTC (200 mg) can begin immediately for patients for whom PrEP is indicated."

So, if the CDC guidelines clearly say that there is no evidence that PEP does delay seroconversion, why are IV/V generation (Ag/Ab) tests for HIV not considered conclusive at the end of PEP. The HIV specialist I see say if you test negative at the end of PEP with a highly sensitive test, you are 99% negative for HIV. Can anyone state evidence on delays caused by PEP? I seem to not find any evidence and it seems to be an issue causing so many people unnecessary anxiety.

[mike_no]

Your doctor has worked out the odds pretty fair and square, a negative at 4 weeks post a low risk exposure despite of being on PEP is a great indication that prophylaxis didn't fail. Nonetheless, PEP wasn't warranted for the nature of risk you possessed.

At this juncture, if you look at this event from a practical standpoint, the chances of you dying from falling off your chair while reading this is a lot higher than being infected from HIV. Reach out for that help, things will get better.

We wish you good luck.

[worried_goose]

Thank you Mike for the reassurance. I'll get tested soon for a conclusive, but based on what you guys and my doctors say, I should be in the clear. Time to move on from this. Fingers crossed for the good new.

[CurfewX]

This is an extremely long post for a simple answer:  Professionals consider 4th-generation tests to be conclusive when taken a month post-last dose of PEP.

I don't know why you're so fixated on this.  Your risk was extraordinarily low.  Most people wouldn't bother testing, much less taking PEP, after an exposure like yours.

[worried_goose]

Thank you for your response. I'm mainly confused because what I read online is contradictory to what my doctor is saying (who is a very experienced infectious disease specialist). I understand my risk is very low, I just would like to know when I can put all this behind me and if the tests I have done already were conclusive, then I would be a lot more relieved.

[CurfewX]

You really should have already put this behind you.  I can only tell you what recognized HIV experts say.  The CDC is ultra-conservative.

The choice of when to accept your results as conclusive is yours alone, but experts say a month post-PEP.  I cannot offer support for anxiety related to some astronomical event that occurred where you had very low risk and don't believe your tests are conclusive.

[CurfewX]

In short, you're testing to see if a unicorn turns up.  It won't.

[worried_goose]

It's very relieving to hear your affirmation. My doctor says very similar things. Overall, I have to continue working on managing my anxieties and rely on the results and the affirmation of my doctors. Thank you very much!

[Sara_MHModerator]

Our members have answered your questions as best they could. Your test results for an extremely low risk exposure are unlikely to change.  We wish you the best.
***  thread closed ***

[worried_goose]

So, I went to see my doctor again today and he said I'm "firmly negative" and that I really need to seek therapy with respect to this. I'm just so confused given the internet says that a conclusive test is 4 weeks post-PEP whereas the doctor says my tests at the four week post exposure mark were conclusive. He was a bit annoyed at me for being so anxious about this. Should I believe him and just accept the fact that am I negative or should I still be under the impression that I could become positive in the next round of testing?

[CurfewX]

Your doctor is correct in that you should seek therapy.  Your anxiety is out of proportion to the risk you had, in the EXTREME.   We've given you all of the testing and risk advice that we can possibly give you.  Asking us to keep answering the same questions again really isn't appropriate as the advice we provide won't change.

[worried_goose]

By the way, in the recommended testing calendar for PEP the CDC lists in the same document, a regular antibody test at 3 months (which is the window period for such tests), is deemed conclusive.
Page 27: HIV Ag/Ab testing(or antibody testing if Ag/Ab test unavailable). The last time for a test is shown to be at 3 months post-exposure

[AnxiousNoMore]

You are wasting your time googling for death all day. You had no risk for the disease that you are wasting so much time reading about. Seek therapy so you can deal with your real problem of mental health instead of just procrastinating by reading on the internet about the disease that you can't have.
You have greater chance of getting hit by a meteorite than hiv from what you did but you don't worry about that. Or you can get cancer at any age but you don't get imaged every day to see if something has gone wrong - yet the odds are much greater of cancer than hiv from your zero risk blood draw - your priorities are all mixed up but a therapist might be able to help with that so you can live a normal life instead of wasting it fixated on the disreality idea that hiv is going to pop up out of the syringe and find an impossible way to infect you.

[worried_goose]

I think you have me mixed up with someone else. I did have an exposure. It is indeed low risk and I'm definitely overthinking it at this point but I'm not worried about a 0% risk event. I do appreciate the help and as I said, I'm working on getting through this overly anxious thinking. I appreciate the help you and all the community members are providing. You all are great!

[AnxiousNoMore]

You're right - I was mixed up actually because I saw your advice on a different forum and associated your situation with theirs which was no risk.

However you've been told by everyone here that you are not the unicorn who will get hiv so there is no purpose doing all the googling that you are doing now - no one here at this point after your testing is going to believe you can be positive since WE realize the CDC is overly conservative - therefore you are really taking up a lot of your life googling hiv for reasons that no one here will ever agree with.