[Question #11491] Help Please Possible Super High Risk Exposure
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14 months ago
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Hi Doctors, I went to get tested in Mexico, where a cousin of mine works as a phlebotomist. I am afraid of syringes, so I did not observe the process; although I observed he got a new blood-taking device, he did not wear gloves.
After the test, we spoke for one hour, and he told me that I shouldn't be worried about taking tests since the lab test is so sensible that he got his positive result 15 days after his exposure two months ago he’s a gay male. At that point, I started to get worried. I don't know if he pricked himself on purpose, and then he took my blood sample. I took an HIV 1 RNA test 10 days later not detected. At 18 days (today) I took a 4th gen test not reactive.
-Assuming he prick himself and then took my blood how high is my risk?
-Assuming he did, if I do another HIV 1 RNA test, when can I consider it conclusive?
-Assuming he did when should I retest to rule out the infection? I’m so worried and I don’t know if my fears are real. Please help me, thank you!
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Edward W. Hook M.D.
14 months ago
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Welcome to our Forum and thanks for your questions. I'll be glad to comment and hope that the reassurance I provide will be helpful. I am confident that you were not exposed to HIV when your cousin drew your blood. Professional phlebotomists are highly trained and there are no cases in which having blood drawn by a professional has led to acquistion of HIV- you are not going to be the first. Several related comments:
1. You have no reason to assume the he pricked himself while drawing your blood. In fact, you point out that you were after him sor a while afterwards- if he'd pricked himself you would have seen evidence of that, i.e. blood, a Band aid, etc.
2. The idea that he would have pricked himself on purpose to infect you is a paranoid statement with no basis.
3. As a health care professional, I suspect your cousin may be on therapy for his infection. If he is on effective therapy for HIV, he is not infectious to others.
4. Phlebotomy equipment is designed to avoid contamination of the blood specimen by the person drawing blood (I should add FYI that the reason that phlebotomists wear gloves is to protect themselves from their clients, not the other way around)
5. HIV RNA PCR tests are conclusive when taken more than 11 days after an exposure. A 10 day test is strong evidence that you were not infected although not quite conclusive. 4th generation tests are not conclusive until at least 6 weeks following an exposure.
If you wish to prove you were not infected, you can get conclusive results with another HIV RNA PCR test at this time. I am sure it will be negative.
I hope this information is helpful. EWH
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13 months ago
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Hi, good evening, doctor. I took a 4th gen test at 28 days, and the result was not reactive. I am planning on taking another test today, DAY 34, but this one will be the RNA HIV PCR of Quest Diagnostic for HIV 1 qualitative. I have some questions regarding this kind of incident.
-Why does the CDC give a guideline for occupational exposure recommending tests for six weeks, three months, and then a 6-month test looking for HIV after a needle stick injury if they consider most of the tests conclusive at 90 days?
-Are needlestick injuries more prone to a “late seroconversion,” or why is this guideline this way?
-What are the differences in testing for these cases?
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Edward W. Hook M.D.
13 months ago
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At 28 days 4th generation tests are more than 99% conclusive. We have never seen nor heard of a person with a negative 4th generation test at 4 weeks who went on to become positive. In answer to your specific questions:-
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Why does the CDC give a guideline for occupational exposure recommending tests for six weeks, three months, and then a 6-month test looking for HIV after a needle stick injury if they consider most of the tests conclusive at 90 days?
The CDC is being conservative. Actually, the CDC, like us, considers 4th generation tests conclusive at any time more than 42-45 days after an exposure. Perhaps the information you found is out of date
-Are needlestick injuries more prone to a “late seroconversion,” or why is this guideline this way?
"late seroconversion is an internet-fueled myth. It does not exist
-What are the differences in testing for these cases?
I'm not sure I understand this question
Again, I think you are over reacting to having your blood drawn by a person who has HIV. There are NO instances in which anyone has been proven to become infected through contamination at the time of having their blood drawn. You will not be the first. EWH
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13 months ago
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-Would you advise against the PCR I’m considering taking tomorrow? (DAY 35 After possible exposure). I already paid for it, but I think I am not performing the test and asking for a refund.
-Is there a difference in the time of detection of HIV depending on the transmission route? As an example, the person who drew my blood told me that he tested reactive to HIV AG AC 16 days after his exposure to another male in sex. Still, I'm asking if there is a difference in the window period due to the transmission way, like more time needed for sex or less time for sharing syringes or needlesticks, something like that explained in the medical literature?
-I know that that is a myth of the internet.
-Still, I’m wondering why the reason is that the follow-up for an incident is up to 6 months as per CDC Guideline when the window period they provide is concise. They clearly say if I test out of the window, period, and it is negative, I DO NOT HAVE HIV, but why is there that difference in timing in an occupational needlestick incident guideline?
I feel the same about overreacting, but it Is hard to avoid thinking about it. Thank you very much in advance doctor!
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Edward W. Hook M.D.
13 months ago
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Thank you for acknowledging that you are over reacting. I understand that while we sometimes intellectually understand something, our emotions and fears get in the way. The internet does not help that with so much misinformation there. In my opinion, in a similar way, the CDC does not help either. The CDC, because they mush speak in broad generalizations and take the position that they cannot "afford" to ever be wrong, tend to be overly conservative, leading people who visit their web sites to worry for far longer than they need to.
Scientifically, there is no reason that a needlestick exposure should take longer than a sexual exposure. In fact, the reverse is true if anything. I would dispute that persons with needle sticks need such prolonged testing- that is certainly not how we operate.
As far as the PCR test scheduled for tomorrow, it is not necessary, particularly if you are spending money you need for other things on an unnecessary test. If you choose to test, your should consider the negative test that I am confident you will get as conclusive.
I hope that this helps. As you know, this 3rd response will be my final response and the thread will be closed shortly. EWH
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13 months ago
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I know that is only 3 answers but can you leave it open so I can share with you my result? Thank you in advance, if is not possible close it thanks doctor
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13 months ago
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Hi Good evening doctor, I took the RNA PCR FOR HIV 1 Qualitative at Quest Diagnostics at day 35 and the result was -NO DETECTED ¿is this conclusive now? can I close the case? Thank you for letting the space open to report my result, thank you very much doctor, have a good day
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Edward W. Hook M.D.
13 months ago
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Thanks for sharing your test results. This proves that you did not acquire HIV. These results are conclusive, without a doubt. Time for you to move forward without concern.
Closing the thread now. EWH
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