[Question #10328] HIV/Hep From Needlestick and When is Result Conclusive

23 months ago

I got a needlestick injury on 8.6 where I poked my finger while giving a patient insulin. My dr ordered an antigen/antibody with confirmation test aka 4th gen or combo and an acute hepatitis test for Hep A, B, and C. The original dr told me no test was conclusive but for me to test at any time for the 1st test then 3 months later. She wouldn't tell me if the results would be conclusive that I have no HIV/Hep at 3 months. The 2nd dr is telling me to test at baseline, 6 wks, 3 months, and 6 months.

1. When will the HIV and Hep test results be 100% conclusive and confirm I don't have anything if the test results come back negative? Is it possible for the result to be neg at 6 wks and come back positive at 3 or 6 months?

2. How soon can HIV and Hep be detected after date of exposure?

3. When should I be testing? I was thinking of testing 8/25 (18 days after exposure), 6 weeks, then 3 months. CDC states 18-45 days for 4th gen. Is test conclusive at 45 days?

4. How likely is it to contract HIV/Hep from needlestick?

5. I have a runny/stuffy nose for past week with no allergies/sickness, dry purple/red lesions on skin, and a yellowish white residue and sores on my tongue. Can these be signs of HIV?

H. Hunter Handsfield, MD

23 months ago

Welcome to the forum. Thank you for your confidence in our services.

First some general comments, then I'll address your numbered questions. If the patient isn't at high risk for HIV etc (male who has sex with men, injection drug user, etc) then it is very unlikely s/he has HIV or other blood borne infection. Second, I'm surprised you don't mention testing of that patient. Standard practice in most hospitals and clinics would be to inform the infection control team or the patient's doctor, in which case the patient might have been tested so you would know for sure whether there was an exposure. Third, the very small gauge needle typical for insulin is unlikely to carry enough blood to infect you -- most needlesticks that have resulted in HIV or viral hepatitis transmission involved large gauge needles used to draw blood, and not small needles used for injections.

As for your doctor's advice, it is theoretically true that few lab tests are 100% conclusive; there's always risk for error, most tests are not truly 100% predictive, etc. Some physicians emphasize these theoretical facts more than others, and this seem to be your doctor's approach. However, the tests you had are 100% accurate or very close to it. Among millions (even billions?) of HIV AgAb (4th generation) blood tests done in the past 10-20 years, there has never been a single case of a false negative result for a test done at least 45 days after exposure (not counting persons who took anti-HIV drugs, which can delay positive results). And the viral hepatitis tests are really just as accurate. Now to your questions:

1. The HIV test is 100% conclusive after 45 days and the hepatitis B and C results probably about the same time. Hepatitis A is not transmitted by blood and really not an issue. (If your childhood immunizations included hep B, you probably will test positive for antibody, but that result alone just reflects the vaccine, not recent infection.)

2,3. These tests start to become positive as soon as 10-11 days after exposure, are about 80% reliable at 18 days, and (as already discussed) 100% by 6 weeks to 45 days. For HIV, you do not need to test beyond 45 days. For 100% certainty for hepatitis B and C, 3 months is about right.

4. Very unlikely in this circumstance, perhaps under one percent chance even if the diabetic patient has any of these infections. But this is why testing of the patient can be helpful.

5. HIV doesn't cause stuffy nose or the kind of skin or tongue problems you describe. And it is not possible to have HIV and have a negative blood test at 18 days. Even though that result does not, by itself, prove you do not have HIV, it DOES prove that any symptoms you have are not caused by HIV.

All things considered, it is exceedingly unlikely you have any of these infections, and you can expect your future test results to remain negative.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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23 months ago

Thanks for your response. I got my first test on 8/30 and those came back negative for HIV and Hep since my provider wanted me to do a baseline. She checked with the lab for the 4th gen and told me their protocol is baseline, 6 weeks, and 4 months for results to be conclusive. You said the HIV tests are 100% conclusive after 6 weeks to 45 days. Would I have to wait until 45 days have passed for my test to be 100% conclusive and not any earlier? Today is the 45th day so I was going to wait until 9/21 since my exposure was on 8/6. If my results are negative after 45 days, that's conclusive for HIV and then would I have to wait 3 months for Hep results to be conclusive? I'm concerned about the white patches on my tongue still. It's not thrush but won't go away even when I'm brushing and I have been having headaches and fatigue - tested neg for COVID. Since my results were negative on 8/30, does that mean these sx are not related to HIV, since if they were, the results would have been positive? I thought flu like sx and thrush were early HIV sx, so I was feeling concerned. Appreciate your help. This has been stressful. My employer refused to test the pt so I don't know if he was positive for anything - he had no HIV/Hep screening done, was in his 30s with diabetes and osteomyelitis, an amputee. It sounds like even if he had HIV, my chances are <1% with an insulin needle.

H. Hunter Handsfield, MD

23 months ago

Thanks for the follow-up information.

There has never been a reported case of it taking longer than 45 days for HIV tests to become positive after exposure, even though some providers recommend testing at longer intervals. It makes sense to follow your own doctor's advice for another test at 4 months, but you are guaranteed of another negative HIV test result; there is no known difference in test reliability at 42 days (6 weeks) versus 45 days, which is CDC's recommendation. Hepatitis B also is conclusive by 6 weeks, but hep C can take longer; that might be your doctor's main reason for a final test at 4 months.

As for thrush (yeast infection) and flu like symptoms, yes they can go along with a new HIV infection -- but both occur far more often in entirely healthy people.

It isn't possible to judge the HIV or viral hepatitis risk without more information about the patient. The vast majority of patients like him do not have these infections; and when they do, small gauge superficial needle sticks rarely result in infection. Even before testing, and even in the patient were known to be infected, I would put the put your odds of being infected with HIV at far under 1% even before you were tested; and with the negative results so far, the odds you were infected are well under one in a million. Almost certainly you are home free: do your best to stop worrying!

Threads are closed after 4 weeks and we're almost there. Let me know if you have any closing questions. And of course your doctor can address these issues, probably as reliably as I can.

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