Follow-up from a couple months ago on daughter w/needlestick

[scareddadplease]

Hello Dr., thanks for your time.  A short time ago, I posted a question regarding my 3 1/2 year old daughter who suffered a community needlestick with an insulin pen needle found in a hotel elevator.  As reported earlier, at 24 days we got RNA PCR tests for HIV (<400 copies) and Hep C (<50 copies), both of which showed undetected.



At 12 weeks (84 days) post exposure she developed strep throat and while she was being seen at an after hours clinic we went ahead and got her blood drawn for her follow-up HIV and HCV testing.  The test she received for HIV was from Quest and was a 2nd generation test according to them (Vironostika).  Her HIV and Hep C tests both came back negative at 12 weeks.  



She has now developed an upper repiratory infection with fever (100-101.5) and stuffy nose (16 weeks post stick).  6 weeks post stick she had a rash on her face and left shoulder.  This is a kid who has hardly ever been sick in her life.  In reading the sites on children with HIV, they all say that the kids get the normal childhood infections, just more often which has got me concerned.  She was completely better from the strep after one dose of antibiotics although we finished the entire course.  She is acting pretty normal with this cold although her throat bothers her in the mornings.



This is a lot of background to get to the main point and I apologize for the length.  My main question is do kids her age 3 1/2 take longer to develop HIV antibodies due to their maturing immune system, therefore extending the window period past the 12 weeks when we had it done, or is that test combined with the PCR at 24 days completely conclusive, even in a 3 year old?  I want to trust the results, its just that my little girl was almost never sick until the last couple months.  Is there any recommendation for further testing?  Her pediatrician has been of little help and readily admits his lack of knowledge regarding HIV and HCV.  Thanks again.

[H. Hunter Handsfield, M.D.]

To my knowledge, young children develop HIV and HCV antibodies just as fast as anyone else and I believe it is impossible that your daughter has either infection or that her symptoms are related any way to the needle injury.  Kids get colds and rashes.  But I'm not an expert on HIV diagnosis in young children.  If your pediatrician can't answer the question, you might call the nearest major pediatric medical center and ask to speak with the physcian on call for the department/division of infectious diseases.  He or she will know.



Good luck--  HHH, MD

[scareddadplease]

Thank you Dr., just wondering if its the testing that brings you to that conclusion.  If so, I will assume that I should arrive at the same.  Thanks again.

[H. Hunter Handsfield, M.D.]

The negative tests;  that your daughter doesn't have any symptoms that suggest HIV; and the near-zero risk of the exposure itself.  Mostly the test results.



HHH, MD

[shygirl1981]

this is very interesting to me. my friend's 5 year old daughter picked up a dirty needle, and claims she poked herself with it.  my friend took her to the doc, and the doc said there was no apparent puncture wound, therefore, he concluded that she wasnt punctured and there was no risk of infection. my friend left it at that and they did no testing!!!!

I'm concerned because I do see a risk, and I think the little girl should be tested.