quick question which need short to the point answer

[MMKK37]

I had a hiv-1 ab screen w refl in 2004 when I was pregnant with my fourth child. It came back non-reactive. I have only been with my husband since then and we are monogamous. Here is my question and it might sound crazy, but I just need someone to tell me that it is. I take care of a lady who has had three open heart surgeries. I have to help her with her feminine pads when she is menstruating, she is in a wheelchair.I have never noticed blood on my hands and don't really know if that would be a risk. My concern is could she have gotten hiv through a blood transfusion and would that put me at risk? Realistically I know the answer is no, I just need to hear it from a proffesional. The reason this is weighing on me is because I had a case of acute hives that lasted 3 weeks which were handles with prednisone, cortisone shot, and zyrtec. At the same time I had a sore neck and back (I do not lift her) but I had no fever. I did have a sinusitis so I thought that could possibly cause a sore neck. Any insight into this would be helpful. Just wondered if that could be related to and early hiv infection.

[MMKK37]

Thanks a million and I will look at the cdc to better educate myself. You were right it is an informal arrangement and she is my cousin who is special needs(down syndrome.) I have used latex gloves , but there have been times when I have had her out shopping or we wereat a friends house and her period had started and I did not have gloves with me. That has maybe happened 10 times at the most. I will use gloves from now on, but I guess if the transfusion was safe and she has never had a sexual partner there should be no concern for me from what you are saying. I feel much better hearing this from you. So to sum it up I was at no risk, correct? I will take your advice and actually ask medhelp to cancel my screen name and I will move on from this.

[H. Hunter Handsfield, M.D.]

Your cousins's blood count is normal, as her doctor probably told you; the detailed results are meaningless with respect to HIV or any other blood-borne infection.  I already said no transfusion risk in recent years.  Did you think I might have changed my mind?

Any more anxiety-driven questions and I will delete the entire thread without further comment.  Take further concerns to your doctor or your cousin's.

[MMKK37]

please just answer on the transfusion

[MMKK37]

I know you said end of thread but I wanted to update you. I talke to her Dr. who said no need for further testing. He did do another cbc this week, her wbc was 5.7 bil(low end of normal?) rbc was 4.26 tril, lymp was 1.8 bil (low end of normal), mono 0.7 and range ends at 0.7, eos were 0.4 and range ends at 0.4, platlets at 206 bil. I was just concerned because some things were low end of normal(lymp,neutr,wbc,rbc) and some were high end of normal(eos, mono, mchc,mcv.).I guess my question is can some people be in range at the low end with some things and high end with others and have absolutely nothing wrong with them?I sent the results to her cardiologist and he emailed me back and said results were fine. Of course my worry is HIV via the transfusion because that is the only way she could have gotten it. There is really no risk if HIV with transfusions these days? I just need these last questions answered so I can put this to rest, her cardio just doesn't have knowledge of hiv like you do. Thanks again.

[MMKK37]

Thanks so much, and I did not think you were implying she had ever been abused, please know that. I just really wanted to know if I had to worry about hiv through a blood transfusion, that is all. That is really all I was concerned about. I will use gloves form here on out. So really the main concern would be other blood borne illnesses that they don't screen for? Thanks again

[H. Hunter Handsfield, M.D.]

Re-read my previous comments carefully and don't assume hidden messages.  I'm not saying your cousin was ever abused.

Anybody who has had open heart surgery, with all the blood transfusions that are usually part of the procedure, is at increased risk of blood borne infections.  A routine CBC will not detect such problems.  As I suggested, this is something you can discuss with her doctor.

One final word of reassurance:  Since you have cared for your cousin since infancy, the odds are good that you have been exposed to pretty much anything she ever carried.  If you haven't gotten sick yet, it's a good bet you never will.  All things considered, this is a very low risk situation.  Using gloves remains a good habit, but not because I think there are particularly high risks in your situation.

That will have to end this thread.  Take care.

[MMKK37]

She has always lived with her mother and my aunt has always been vigilant about not letting her go anywhere without her or myself. The gynecologist that we see has confirmed she has never been sexually active. I am confused about what you said about testing, did you mean if she had been institutionalized than she should be tested because she could have been abused? So basically if she hasn't been sexually active or abused and blood transfusions are safe than there is no risk of hiv? The only concern would be hep b and c and that is ever so slight? Also, she has a qbc done in the Dr's office and everything was in range, that was last week. Her open heart was 16 months ago so I would say it is pretty safe to assume something in the blood would look funny in regards to blood borne illness. If you could just clarify these last few questions I can end this thread and move on. I will definetly use latex gloves, I just never until recently thought much of it since I have helped take care of her since infancy. Again thank you

[H. Hunter Handsfield, M.D.]

Yes, I agree "to sum it up" that there is no HIV risk.  That said, in this situation it would be reasonable to assure that your cousin doesn't have any of the more serious blood-borne infections, i.e. HIV and hepatitis B and C.  As I said above, there is no risk these days for HIV from blood transfusions, but hep B and C, although unlikely (due to screening of donated blood), remain possible. In addition, I will point out that institutionalized women with Down syndrome sometimes have been sexually abused -- I haven't a clue whether that is a remote possibility in your cousin's case -- but anyone who has had multiple transfusions, heart surgery, etc might reasonably be tested for such infections.  You might discuss it with her doctor.  However, if the doc says it isn't necessary or recommended, you can go with that judgment.  Finally, if testing is done and the results are negative, that doesn't give a green light for handling your cousin's blood and body fluids without gloves.

[H. Hunter Handsfield, M.D.]

OK, directly to the question at hand:  "Realistically I know the answer is no, I just need to hear it from a proffesional."  Your rational assessment is correct.  There is no realistic chance the lady has HIV; nobody has caught HIV from a blood transfusion in the US or other industrialized countries for the past 15-20 years.  And if she were infected, you really were not at substantial risk anyway.  The sinusitis, prednisone, and hives make no difference.

Of course, every person handling another person's blood or body secretions should routinely use latex or plastic gloves, not just to protect against HIV, but against any other possible infectious agents that a person may carry, such as hepatitis B and C, and possibly even viruses not yet even known.  Presumably you are a health worker, in which case your employer undoubtedly provides those guidelines.  If this is a less formal arrangement and you have not been given such guidelines, you can contact your local or state health department for advice.  But all this is just common sense; it doesn't mean there is a signficant risk of HIV.

Your questions here and on the HIV community forum suggest you are qutie fixated on HIV, despite absence of any significant risk.  It is good you are attempting to educate yourself, but you should go beyond asking questions on this or other forums.  Visit websites like those run by CDC (www.cdc.gov) or your local or state health department for lots of information about HIV transmission risks.

Best wishes--  HHH, MD