I posted this question on the occupational hazard board 5-6hrs ago and haven't received a reply yet, so I thought I would try here.
I am a Law enforcement officer, and had a suspect spit in my eyes on 1/3/08. I was treated at the local ER within 3 hours, and placed on Combivir (1 tab twice a day). The local health dept. took samples of the suspects blood. His Hepititus C test was positive, (STILL HAVEN'T GOTTEN THE HIV OR HEPITITUS B TESTS BACK FROM THE STATE'S LAB).
Since taking the Combivir, I have been nausea and fatigued. Then on 1/12/08 I am hopistalized for dehydration, due to vomiting(Kept overnight then released / did have a fever 100-102). They believe I had a stomach virus, and took me off the Combivir for two days.
My question is do you think I should restart the combivir, being I have been off of it for two and a half days? What are my risks to any of the hazardous viruses with this type of exposure. Note: They never flushed my eyes, but I did clean my face with a bacterialcide directly after the incident. And lastly I do have a small spot on the white part of my left eye, that I was told came from sun exposure, and it is usually seen on individuals around the equator (can't remember the name).
First, sorry about what you had to go through doing your job protecting us. You should also be aware that most of us here are Hepatitis C patients and not doctors.
That said, I believe Combivir is to help prevent HIV (AIDS) in the event that you were exposed. I do not think it has any effect on Hepatitis C.
Your exposure to Hepatitis C is very low risk but testing is prudent.
Given the suspect's Hep C status, the best person to advise you on further testing (and what to do re the Combivir) would be a liver specialist (hepatologist) and ideally one who works with HIV patients. Hepatologists can usually be found at your larger, teaching hospitals. Of course you will have more information when the HIV tests come in, and I assume they also tested for Hepatitis B?
Again, I don't think you have too much to worry about, but further testing and consultation with a medical expert seems like the right thing to do.
Very low chance of transmitting HCV in this fashion, a bit higher for HIV and still higher yet for HBV.
For all these viruses it depends dramatically on the viral load that is present in the inoculum.
For HBV for example, it can be from a a few thousands to 10 billion per ml of plasma. It is obvious therefore that the chance that a transmission occurs in a particular case in itself varies by an incredible factor of one million for HBV.
Thus it would be prudent to obtain not just a simple serological answer re the serological status of the assailants blood, but also, if serologically positive for any of these viruses, but particularly HBV, to determine the viral load present. It is feasable, also, to determine a viral load from the suspects sputum, to give an even better idea for risk estimation.
I assume that you are not vaccinated against Hepatitis B. If so this might be a good time to catch up with that, since violent contacts with infected persons are always a real possibility.
A protective shot with Hepatitis B immunglobulin ( HBIG) would also have been iin order, that would have best protected you against the HBV risk, if not vaccinated.
The combivir contains as one component Lamuvidine, that is both effective against HIV and HBV, but full protection is not assured, since these antivirals only work once the virus has entered the host cell and begins its replicative cycle.They do not protect against primary infection/cell entry as HBIG, a neutralizing antibody does. Nevertheless, it should provide a very substantial reduction of risk.
Not to scare you, but many HIV infected individuals carry the lamivudine resistant strain. A better protective antiviral would have been Tenofovir ( Viread), that also provides potent double protection against both HIV and HBV and carries a very small risk of preexisting resistance against HIV and literally none against HBV.
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