occupational needlestick exposure

[Mommy2one2007]

Hello Drs, Just a few f/u questions. I had an occupational needlestick exposure to an HIV positive patient with a viral Load of 139. ( one hundred thiry nine)  using a butterfly needle size 23 guage by 3/4. on December 6th 2011. I was put on a three drug pep cocktail of norvair, presista, and truvada. (spelling?) anyhow, I completed the 30 day course of pep and have had the following testing.
1. at 16 Days ON pep medication the ID dr ordered an HIV RNA by PCR- this came back undectable down to 20 copies.
2. at six weeks post exposure- Negative hiv antibody and negative hep C
3. at 16 days OFF pep medication and ( 46 days from exposure) another HIV RNA by PCR-- undectable down to 20 copies.

I unfortunately was fired from my job due to this exposure. So I have been on my own for testing. At 10 weeks and two days, (11 days shy of three months, or 84 days) I had an oraquick advance mouth swab- Negative

My questions are as follows:
1. I have consulted with Drs at the pep hotline who believe i am negative from these tests and should put it in the past. Do you agree?
2. I realize that the body does not have an internal timer that sets itself to the three month mark and a person is going to test negative at 83 days, and then all the sudden be positive at 84 days. I realize that the CDC states three months for there guidelines. How much can i rely on my 73 day or (10 week and two day ) test? is this close enough to the three month mark.
3. I plan to return for a six month hiv test, but since the employer will not do anymore tests nor will the allow me to see the Id dr anymore, do you feel this test is necessary?
This patient was also tested  at the time of exposure for hep B and C and was NEGATIVE.
thank you for any help you may provide.

[Edward W Hook, MD]

The answer would be the same irrespective of the depth of the stick.  

This ens this thread.  EWH

[Mommy2one2007]

Thank you for your answers. My final question is, for sake of arguement if this was a deep tissue needlestick would I need to test out further, or are my recent tests enough to rule out hiv? You said that I had "nearly" definative evidence now. anything I can do to be 100% sure? Or am I already there? Please clarify. Thank you again for all your time and help. Feel free to close this thread with your final answer. Thank you.

[Edward W Hook, MD]

Welcome back to the Forum. I know from our earlier interchange that you are quite concerned about this exposure.  As we discussed before however, as exposures go, this was a VERY low risk needle stick an you took highly effective preventative therapy.   You now have nearly definitive evidence that you did not get HIV.  It is time for you to put this behind you and move forward, not dwell in the past.  

I will briefly answer your specific questions but will not get into a prolonged exchange- it is not necessary.  

1. I have consulted with Drs at the pep hotline who believe i am negative from these tests and should put it in the past. Do you agree?
I agree.  I really see no need for further testing.  

2. I realize that the body does not have an internal timer that sets itself to the three month mark and a person is going to test negative at 83 days, and then all the sudden be positive at 84 days. I realize that the CDC states three months for there guidelines. How much can i rely on my 73 day or (10 week and two day ) test? is this close enough to the three month mark.
I would rely on it very much.  I see no reason for you to test further.

3. I plan to return for a six month hiv test, but since the employer will not do anymore tests nor will the allow me to see the Id dr anymore, do you feel this test is necessary?
No, I do not feel it is necessary from a medical perspective in your case.  EWH