Is A Negative HIV Test Result 3 Days After Unprotected Intercourse Conclusive?

Posted on Wed, 1 Feb 2017

Question: Doctor,
I had unprotected sex with a sex worker two times in Thailand within the last 3 days. I started taking post exposure prophylaxis (PEP) drugs (TRUVADA) from the 3rd day. I got myself and the sex worker tested for HIV today (4th day) and it was negative for both of us. also I don't have any symptoms of any sexual disease so far.
I have some queries:
1) She's HIV negative as per the blood test she had today. but i read hiv antibodies are producted only 3 weeks after the exposure. so could she be still infected?

2) considering (1) and her profession (sex worker), is there still possibility of me getting HIV infection from her due to the unprotected sex i had with her?

3) is it still worth taking PEP to completely prevent any possibility of getting HIV infection?

4) should I ask her to do the viral load test? does viral load test also look for hiv antibodies? or will it detect the virus itself?

Answered by Dr. Chakravarthy Mazumdar (23 hours later)

Brief Answer:
Risk is there

Detailed Answer:
Hi,

I know how anxious you are about this. I am sorry for being late which is unusual for me.

1) yes, the viral antibodies start production late after 3 weeks.
2) we never know if a sex worker who accepts unprotected intercourse can always be risky.
3) you should get pcv viral load test done for her.
if there is no virus you can suspend ART therapy.

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Chakravarthy Mazumdar (1 hour later)

Thanks a lot Doctor for the detailed reply. No issues with late reply.
1) I checked with the Girl on the HIV pcr test but she's not willing to co-operate. I am planning to get the PCR test done for myself and i am planning to continue with PEP drugs till then. when should it be done after exposure?
2) PEP drugs:
earlier i took atripla but it was too strong for me hence switched to Truvada (emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg). In thailand, one doctor suggested taking edurant 25mg (Rilpivirine) along with Truvada.
What would you suggest? is truvada not adequate as PEP?
3) Side effects of PEP
i read PEP drugs such as Truvada and edurant can cause serious liver/kidney problems. but is it safe to take them atleast for 28 days?

Answered by Dr. Chakravarthy Mazumdar (26 hours later)

Brief Answer:
You can test with pcv for HIV

Detailed Answer:
hi,

you can test with pcr RNA for HIV or even a HIV duo test.
Both of them would be good after 15 days post exposure.
regarding PEP the guidelines differ country to country. I would suggest to follow local guidelines by a sexual medicine expert. generally the local doctors know about resistance to various drugs. Truvada should be good enough now as per XXXXXXX guidelines.
The benefits of taking PEP out grow the side effects hence should continue. Also the side effects vstart declining once you stop them if proven contrary.

All the best.

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Aparna Kohli