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Risk, PEP, Testing and Outlook
Dear Drs,
I am a medical student who was on elective in trauma surgery in Johannesburg. During insertion of a chest drain I must have torn my glove while bluntly dissecting and putting my finger into the pleural cavity. I had the blood/fluid on my finger for at least 30min as I didn't realise until I had finished closing his stab wounds. I didn't feel a prick, and I don't have open wounds on my fingers, but I do have dry skin and tags and some cracks around my finger nails.
HIV came back positive on the man and I started Aspen Lamivid 300/150mg BD within 2 hours. I have a course for 28 days.
My questions are.
1. What is my risk of acquiring HIV with and without PEP?
2. When is the earliest I will know absolutely know for sure that I will be negative? I would never forgive myself if I infected my girl friend.
3. Does PEP affect the testing reliability? It would seem plausible that PEP might delay positive result ELISA or PCR.
4. Am I on the correct PEP regimen?
Thanks for your wisdom and experience
ICC.
I am a medical student who was on elective in trauma surgery in Johannesburg. During insertion of a chest drain I must have torn my glove while bluntly dissecting and putting my finger into the pleural cavity. I had the blood/fluid on my finger for at least 30min as I didn't realise until I had finished closing his stab wounds. I didn't feel a prick, and I don't have open wounds on my fingers, but I do have dry skin and tags and some cracks around my finger nails.
HIV came back positive on the man and I started Aspen Lamivid 300/150mg BD within 2 hours. I have a course for 28 days.
My questions are.
1. What is my risk of acquiring HIV with and without PEP?
2. When is the earliest I will know absolutely know for sure that I will be negative? I would never forgive myself if I infected my girl friend.
3. Does PEP affect the testing reliability? It would seem plausible that PEP might delay positive result ELISA or PCR.
4. Am I on the correct PEP regimen?
Thanks for your wisdom and experience
ICC.
MEDICAL PROFESSIONAL
Dr. Hook and I do not comment on each others' replies unless one of us asks the other to do so. That is rarely necessary; we almost never disagree with one another and you can be sure his opinion would not differ significantly from my reply above.
Sorry about your situation and I am very confident that you will be okay.
I was just wondering, did you have dermatitis? Because PEP guidelines in the states say that PEP should only be administered if the person has dermatitis, abrasion, or open wound. Was your skin oozing?
I am not sure if you would have even been perscribed PEP in the states.
I was just wondering, did you have dermatitis? Because PEP guidelines in the states say that PEP should only be administered if the person has dermatitis, abrasion, or open wound. Was your skin oozing?
I am not sure if you would have even been perscribed PEP in the states.
Dr Hook,
What is your opinion on this?
Also the drugs I am on is called Aspen Lamizid 300/150mg BD.
Cheers.
What is your opinion on this?
Also the drugs I am on is called Aspen Lamizid 300/150mg BD.
Cheers.
MEDICAL PROFESSIONAL
Welcome to the HIV prevention forum. Sorry to hear of your exposure, but congratulatons for being on the right path to successful prevention. I'll try to help, but there is no substitute for personal, professional advice, which presumably you are getting -- and my bet is that the people who prescribed the PEP, especially at a medical school or major medical center in South Africa, know more about it than I do (or Dr. Hook does).
1) The risk for such exposure undoubtedly is quite low. To my knowledge, there are no data at all on the risk related to skin inflammation like you describe, only rare case reports, insufficient numbers to calculate the actual risk Presumably the risk is higher with prolonged exposure (like you describe), but I would think it still lower than with overt needlestick injuries in the presence of HIV infected blood, for which the risk has been estimated in one study as 0.3%, i.e. 3 per 1000. An unknown factor, however, is the viral load of the infected person. If your patient is on ART and/or has a low viral load, you may be at no risk at all.
2,3) You should follow the advice of the doctors responsible for your PEP. Most likely they will recommend standard HIV antibody tests at various intervals. You are correct that PEP logically could delay but not prevent infection, resulting longer seroconversion intervals. Unfortunately, no data exist on this. So it might be several weeks after completion of PEP that testing will be definitive. Testing for p24 antigen and/or PCR testing (as for HIV viral load) might give earlier answers. In any case, assuming you haven't had sex with your partner since the blood exposure, she obviously is not (yet) at risk. But you will need to abstain (or use condoms consistently) for at least several weeks.
4) I am not familiar with that particular product. The name implies it contains lamivudine (which is good) plus another drug. It is highly like that the HIV experts at your insitution are up to speed on the proper regimens for PEP in Jo'burg. But if you have doubts, you should ask them directly whether there are other options to consider.
All things considered, the odds are very strongly in your favor. Try not to be too wigged out over this. Most likely all will be well. Good luck.
HHH, MD
1) The risk for such exposure undoubtedly is quite low. To my knowledge, there are no data at all on the risk related to skin inflammation like you describe, only rare case reports, insufficient numbers to calculate the actual risk Presumably the risk is higher with prolonged exposure (like you describe), but I would think it still lower than with overt needlestick injuries in the presence of HIV infected blood, for which the risk has been estimated in one study as 0.3%, i.e. 3 per 1000. An unknown factor, however, is the viral load of the infected person. If your patient is on ART and/or has a low viral load, you may be at no risk at all.
2,3) You should follow the advice of the doctors responsible for your PEP. Most likely they will recommend standard HIV antibody tests at various intervals. You are correct that PEP logically could delay but not prevent infection, resulting longer seroconversion intervals. Unfortunately, no data exist on this. So it might be several weeks after completion of PEP that testing will be definitive. Testing for p24 antigen and/or PCR testing (as for HIV viral load) might give earlier answers. In any case, assuming you haven't had sex with your partner since the blood exposure, she obviously is not (yet) at risk. But you will need to abstain (or use condoms consistently) for at least several weeks.
4) I am not familiar with that particular product. The name implies it contains lamivudine (which is good) plus another drug. It is highly like that the HIV experts at your insitution are up to speed on the proper regimens for PEP in Jo'burg. But if you have doubts, you should ask them directly whether there are other options to consider.
All things considered, the odds are very strongly in your favor. Try not to be too wigged out over this. Most likely all will be well. Good luck.
HHH, MD
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