blood in cuts on hand

[mildly_concerned]

I have had several bleeding cracks on my hands from a combination of dry winter skin and playing music. two nights ago I shook hands with a fellow who had just cut his hand open punching a wall. I didn't notice at first, but I looked down and saw that my hand had a large amount of blood on it. I can't be sure if I had open cracks or not at that moment, but I went home and washed my hands as soon as I could, the blood had dried at by that point. this is in the US. how much of a risk is this for HIV transmission? I don't know the status of the person who's hand I shook.

thanks

[H. Hunter Handsfield, M.D.]

Welcome to the forum.

I find it interesting that you made a comment on another thread, reasuring the questioner in a way that made it seem you understand HIV transmission risks -- but still for some reason are concerned about the exposure described here.  If HIV could be transmitted through the sort of events you describe, don't you think there would be the occasional case in which someone without obvious sexual exposure or shared injection equipment had HIV?  But there are no such cases.

Cuts begin to seal up against outside contamination quite rapidly.  And the odds the person with whom you shook hands had HIV seem very low as well.  It is likely that nobody in the world ever caught HIV in this manner, and I'm sure you won'g be the first.  There is no risk at all, and no testing is needed.

Best regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

HCV is more easily transmitted than HIV, but still very low risk.  However, I don't know whehter there has been any research related to such exposures; as you predicted, this isn't my area of expertise

[scaredwithocd]

i know this is an HIV forum, but i'm just curious if there is a risk for HCV in this situation? or is it one of those can't be measured with any frequency/ "no risk" situations that don't warrant worry or testing?  thanks

[H. Hunter Handsfield, M.D.]

This exposure does not meet anybody's standard criteria for PEP.  The guidelines you have quoted are clearly labeled for occupational exposure, and they cite only a 0.3% transmission risk if the source of blood is known to have HIV.  Also, they state " To make sound PEP recommendations, the clinician must assess the risk of HIV infection from the particular exposure. After this assessment, the clinician and the exposed worker must discuss the possible benefit of PEP (given the risk of HIV transmission from the injury)...."  That is what I have done.

To my knowledge, there has never been a single case of HIV transmission documented to occur anywhere in the world over the 30+ years of the known HIV/AIDS pandemic from non-occupational blood exposure outside health care settings.

So you have my judgment.  What you do with it is up to you.  But my advice remains that you don't even need HIV testing, let alone PEP.

[mildly_concerned]

I can't find what I was referring to right now, but in this table for occupational exposure they list PEP as "Recommended" for "After Mucous Membrane Exposures and Nonintact Skin Exposures" http://www.aids-ed.org/aidsetc?page=cg-301_occupational_pep

[mildly_concerned]

well of course anyone who reads the literature on hiv risks will find warnings about bodily fluids on open wounds or mucous membranes. I read a case study which listed at least 3 cases in which health care workers tested positive after being exposed to HIV+ blood to their mouth and eyes. the other poster was worried about just touching somebody. I agree that the situation I'm in would be very low risk. is there any reference you could give me on the lack of evidence of transmission via wounds and/or the protective layer the body creates ("quite rapidly"). I trust your opinion, I would just like more evidence.

thanks again

[H. Hunter Handsfield, M.D.]

PEP is not necessary or recommended after events like this.  And you probably couldn't find a doctor or clinic willing to prescribe it anyway.

[mildly_concerned]

also, what would the costs and benefits of receiving post-exposure prophylaxis be at this point?