Exposure to HIV positive blood

[callistar]

My uncle was diagnosed with HIV in December 2012.  On Saturday he and I attended my cousins wedding.  As we were standing in line to greet the bride and groom the bride’s mother walked up to us and gave my uncle a hug first and then gave me a hug.  As she hugged me I felt a sharp sting and said OUCH rather loudly; my uncle turned to me and said that corsage pin must have stuck you too.  I looked down at her corsage and a piece of wire from the bow was sticking out then I looked down at my arm and saw a red mark with a few droplets of blood.  My uncle’s wound on his arm looked the same as mine with a little blood.  I don’t know why he didn't say anything when it first occurred, because I would have been a lot more careful or my aunt could have fixed the problem.  I didn't say anything else to my uncle about the situation, because after it happened he and my aunt just laughed it off, but I was panicking on the inside.  I don’t want my uncle to feel that I’m scared to be around him, because he has enough to deal with already.  To top all this worry off, I’m breast feeding my 4 month old son.  I’ve been pumping since Saturday and letting him drink milk that’s been frozen.  I know I need to become more educated and I love my uncle deeply, but this just took me by such surprise.  My question is could there possibly be a risk of me becoming infected with HIV since both sticks happened almost immediately and would it be okay if I start breast feeding my child again?

[H. Hunter Handsfield, M.D.]

Welcome to the forum.  Thank you for a well stated question -- and for a sober tone.  A lot of people in your situation would be panicked -- which you clearly are not.

We generally advise that superficial injuries in the environment -- i.e. outside healthc are settings -- carry no risk.  And probably there was no risk here either.  However, with your uncle having a relatively recently diagnosed (and perhaps not yet treated?) HIV infection, and your apparent injury "immediately" after he was stuck with the same pin or wire (drawing blood in both instances), in this case I think it's reasonable to take some precautions.

I stress that even in these circumstances, I would consider this to be a very low risk risk event.  The tiny amount of blood that could have remained on the pin almost certainly would have dried, killing the virus.  The only known instances of sharp instuments transmitting HIV have been when injection equipment was shared by drug users, and in medical settings -- and in these, the injury was almost always more substantial than yours, with a hollow needle or an overt injury with a scalpel or other sharp instrument.  But I cannot, in good conscience, say this was a zero risk event.  However, as implied above the actual risk would depend in part on the status of your uncle's HIV infection.  If he is taking anti-retroviral thereapy (ART, i.e. anti-HIV drugs) and has a low viral load, than there was probably no risk at all, even with a much more severe injury.

My advice, therefore, is that you first speak with your uncle.  Given your close relationship, he'll probably understand and won't take it personally.  Ask him if he is on ART and, if so, whether he has a high or low viral load.  If so, I think you can safely discount this event.  If not, then the next step should be to contact your personal physician -- or even better, perhaps the doctor or clinic providing your uncle's HIV care -- then follow their advice.  It is possible they will advise early testing, and perhaps continuing to abstrain from sex with your husband and breast feeding, and maybe even post-exposure prophylaxis (PEP), i.e. short-term ART to prevent infection.  

Do these things ASAP; if PEP is recommended, it should be started within 72 hours of the exposure.  In the meantime, I think it probably is reasonable for you to continue to abstain from sex with your husband and from nursing your child.

Let me re-state that I believe your risk is extremely low, even in the worst case scenarios implied above. But better safe than sorry.  Please return with a follow-up comment to let me know how it all works out after you have been professionally evaluated.

Best regards--  HHH, MD

[H. Hunter Handsfield, M.D.]

Thank you for the follow-iup.  I'm very glad to hear your uncle is on treatment and has a very low viral load.  I agree exactly with your uncle's doctor and I do not think it is necessary for you to stop nursing your baby or have only safe sex with your husband.  Even at a personal level (e.g., if you were my own patient or even my daughter) -- I would advise that these precautions are not necessary. However, I understand where you are coming from, and it's your choice.

Thanks for the thanks.  Take care.

[callistar]

I spoke with my uncle after reading your response.  He is on a combination ART and has been since December.  His viral load was around 400 at his last appointment in March.  He spoke with his doctor about the situation and was told that with current treatment and his viral load considered low there is no need for me to take PEP.  He was also advised to tell me that this could be considered as an extremely low risk (almost remote) and possibly an environmental exposure.  I don’t want to take any chances, so I will not continue to breastfeed and will use protection with my husband.  I am going to test in the coming months – just to be sure.  I will let you know the outcome (sometimes you just have to have faith).  Thank you so much for your quick and concerned response.