Please make sense of this for me

Hi there,

Long story short, I'm a nurse who got a small amt of blood tinged bodily fluid in my eye.  I was started on PEP that night after the patient tested POSITIVE on the rapid HIV test.  Three days later, the pt's IMCA test came back NEGATIVE.  At this point, the occupational health MD told me that I was in the clear, but the infectious disease Dr. I am seeing told me to continue taking the PEP and that he was running a PCR on the pt to make sure.  From what I've read the PCR is NOT recommended and not a diagnostic test because of the rate of false positives... so why did he order it?!  What if it comes back positive?  How do we know for sure this pt is not HIV positive?  I feel like I'm getting so many different answers, and it is such a vulnerable time.  I very much appreciate advice.

[Edward W Hook, MD]

Welcome to our Forum.  I can understand how the combination of an exposure of the sort you describe, combined with mixed messages about the testing of the patient from whom the exposure occurred, could be a source of concern.  Here is the issue. for better or worse, there are no perfect tests.  Current tests for HIV, including the IMCA test however come very close.  Very, very rarely however there are mess ups in the lab or the test does not perform as designed (this is probably what happened with the rapid test).  Thus the advice you received from the occupational health MD was based on this and is the same advice I would give you.  Unless the Infectious Disease doctor knows something about the patient that you haven't mentioned however, I think his/her decision is an example of choosing to be very conservative and to work to get a “tie-breaking test result” to be "extra sure" that the source patient did not have HIV.  I probably would not have done this and know that it is causing you some anxiety.  He is doing it in your interest however.  As an unrelated example, the analogy is doctors who tell people to test for HIV out to 3 or even 6 months "just to be sure" when all of us who work in the field are confident that 8 weeks is sufficient time to get reliable blood test results.  

Try not to worry while the PCR is being processed.   I hope this comment is helpful.  EWH