[Question #12409] Possible contact with HIV+ blood
8 months ago
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Hi Drs,
Just had a new exposure. A week ago I visited ER because of a sudden and severe enterogastritis and there was a person who just survived a car crash queuing in front of me. The guy was basically bleeding everywhere and coughed constantly, which made several small drops of blood land on my clothes and hands, before his stretcher was sent in. I learned from the conversation between this man's friend and the doctor that he was HIV POSITIVE, took some medication before but not sure if it was continuous and whether he was still taking it before the accident. I was wearing a mask and glasses so did not care about other splashed blood but the blood on my hands was worrying me a lot. I often scratch my thumb using index finger so near the nail, that part of skin was not in a good shape and had scabs and callus, and bleeds a bit occasionally. I am afraid that some blood might have contacted that area, which makes me quite worried about the possible HIV infection. What is my risk for this exposure? PEP is definitely too late now so I am really anxious at this time. I am not sure if my thumb was bleeding during that time, but I think it should be unlikely.
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H. Hunter Handsfield, MD
8 months ago
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Welcome back, but I'm sorry you found it necessary. This was a completely non risky event; nobody in the world has ever caught HIV from being near a bleeding person, even someone with HIV. You were not exposed at all. And even if you had blood contact with a scratched area of your skin, it would have been no risk. You do not need testing for HIV.
It is apparent from both this question and your last thread that you have greatly inflated fears of HIV, far beyond the actual risk associated with possible exposures. It is far more difficult for HIV to be transmitted than you seem to think.
---HHH, MD
8 months ago
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Hi Dr. Handsfield,
Thanks for your reply. I also felt like this may be less risky than it seems to be because there was no physical contact between me and the HIV patient at all, but this case report made me worried about splashed blood: https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/transmission-of-human-immunodeficiency-virus-hiv-to-a-family-caregiver-through-a-conjunctival-blood-splash/78FED2E52012E7584B2500355AE0E1D9
I have read that the average risk for similar eye/mouth mucosal exposures is around 1/1000. It seems that my encounter has some similarities with such exposures (splashed HIV+ blood on mucosal membrane/non-intact skin), so may I ask why for my case it is a no-risk event for sure? I thought if the infected blood contact the non-intact skin which potentially bleeds a little might have imposed a risk. In addition, I found someone saying that for outside body blood-blood contact to actually transmit the virus, both the negative person and the HIV patient must both have open, deep, heavily bleeding wounds and they must closely contact each other for some duration to make transmission possible. Do you agree with this statement?
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H. Hunter Handsfield, MD
8 months ago
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Your compulsive obsession is taking you to a bad place. Do you really think this situation has anything to do with your event? The very reason that unusual or mostly unheard-of events generate case reports in the medical literature is that they are exceedingly rare! And the infected person was aware of the contact of fluid with her conductive. Can I say yours was zero risk? Yes, because you did not get a splash into your conjuctiva. Or any other contact that could transmit HIV. You came here for our professional and -- if I say so myself -- world class advice. Accept or reject it, I don't care -- but this isn't a debate.
Your statement about deep wounds and similar exposures is accurate; I agree.
Perhaps you would also like to know that in the 21 years of this and our preceding forum, with thousands of questions about exposures that made people worry about HIV, not one has yet turned out to be infected. If and when it finally happens, I am confident it will be a genuine high risk exposure (think unprotected anal sex between two men) and not another one case in millions.
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8 months ago
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Thank you Dr. Handsfield, now I feel much more reassured. I just have several questions out of curiosity:
1. What actions will you recommend if someone actually got splashed HIV+ blood into their eyes or mouth?
2. Why does outside body blood-blood contact has to satisfy more stringent conditions for transmission to occur (open, deep, heavily bleeding wounds come to close contact for some duration) , but needle stick injuries could transmit the infection with only a small amount of blood, is it because of the pathway that virus gets into one's body?
3. Can I say with absolute confidence that transmission will never occur in any circumstances if there is some distance (say, > 1.5 meter) between the negative person and HIV+ person?
Thanks.
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H. Hunter Handsfield, MD
8 months ago
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1. Almost certainly this will never happen to you. If it does, see a doctor or clinic for in person evaluation of the risk and consideration of a testing schedule and/or PEP.
2. The large majority of needle injuries with HIV infected blood do not result in transmission of the virus. Before PEP became available, under one in a thousand health care providers who sustained needle or other sharp instrument injuries involving HIV infected patients become infected. The risk is higher for drug users who share needles and syringes, but still it generally takes many such shared equipment events before someone becomes infected.
3. "Absolute" confidence, that is 100% assurance? Of course not. Anyone can imagine a situation that could splash blood or infected body fluids that far, and contact with eyes or substantial wounds. However, such cases are extraordinarily rare if they occur at all. You're probably at higher risk of being struck by a meteorite, but I would not advise you to take precautions against it.
Have only monogamous or otherwise safe sex and don't share drug injection equipment with anyone. That's all you need do to avoid HIV (and syphilis).
That completes the two follow-up exchanges included with each question and so ends this thread. Please note the forum policy against repeated questions on the same topic. This being your third about near-zero risk sexual and nonsexual events and your concerns about HIV and other STDs, it must be your last. Repeated anxiety driven questions are subject to being deleted without reply and without refund of the posting fee. We're not keen on collecting fees for questions with obvious answers; repeated replies often prolong anxiety rather than relieving it (there's so often a "yes but" or "could I be the exception" sort of thinking); and such questions have reduced education value for other users, one of the forum's goals. Thank you for your understanding.
I do hope the discussions help you move on with no further worries along these lines.