[Question #252] HIV from Two Small Cat Scratches

36 months ago
My name is Jedd. I had a recent encounter one and a half months ago with an HIV positive friend of mine and a cat. The cat scratched him and did not draw any sort of blood initially. He had to squeeze the paper cut type wound for any blood to appear, which was a minor trace amount anyways. Then 4-5 minutes later, the cat came over and scratched me very lightly in two places on my hand and wrist. The scratches barely turned red from blood. 

My friend's viral load was 20-30 copies per milliliter at the time. He is on ART medicine and has been on it for 3 years. However, on his drug regimen of Truvada and Isentress, he had been off of his Isentress for 3-4 days prior due to prescription refill issues. He was still on the Truvada though at the time of the incident. I don't know if that can cause an undetectable viral load to spike to 50,000 copies or more suddenly or not.

Anyways, I rushed to the ER afterwards in a panic and got on PEP (Truvada and Isentress for 28 days). I got the drugs into my body within 2 hours of the incident. I had a minor cold on the 20th day of PEP. It lasted 2.5 days. My temperature went to 99.5F. I also had a minor stomach pain for 1.5 days on the left side of my body. My temperature went up to 100.2F for 4 hours. The pain immediately went away after this. 

I also want to mention that I have no way of knowing if the cat claw that scratched him also scratched me (cats have many claws)... and also that I checked with a vet practice and they said cat claws are not like hollow point needles. They are actually solid claws and not like snake fangs. 

What are my risks for an exposure like this? Does HIV dies with contact to the air for 4-5 minutes? What impact does my friend's undetectable viral load have on this situation? Why am I still feeling somewhat fatigued and kinda worn down?


My weight is as follows over the last month:

145 lbs 10/21/15

147.4 lbs 11/3/15

146.2 lbs 11/10/15

145.8 lbs 11/11/15


145.8 lbs 11/12/15

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Welcome to the forum. Thanks for your question.

This was an exceedingly low risk situation. I'll bet nobody in the world ever caught HIV from cat scratch or any other interaction with a pet of an HIV infected person. Had you been my patient, I would not have recommended or prescribed PEP. Now that you have done that, however, the clinic or doctor who prescribed it really should be your main source of information, reply to questions, etc. I'll give you my thoughts, but be sure to check with that doctor or clinic as well.

First, the vet is right about cat claws. Any exposure is more analagous to a non-hollow sharp instrument exposure, not an injection needle. Second, with your friend's very low viral load, he is minimally infectious if at all. The need for PEP would have been uncertain even if you had had unprotected sex with him. The viral load probably would not rise significantly after only 3-4 days off treatment. Third, it is true that HIV dies immediately on drying, and I would guess that any blood on the cat's claws -- i.e. the very small amount that could adhere to a claw -- would be dry within a couple of minutes. That said, the biological reasons for low risk really aren't what's important. What matters is that nobody has ever been infected in this fashion and on that basis alone we can be confident there was no measurable risk of HIV transmission.

The final issue is your symptoms. There are innumerable reasons why a person can feel fatigued and worn down. I can only speculate about PEP side effects, psychological (e.g. anxiety over all this business), or some other entirely unreliabed problem. But there is no reason to suppose it's due to HIV; these would never be the only symptoms of a new HIV infection. Your weight fluctuations are entirely within normally expected day to day variations due to diet, exercise, fluid intake, etc.

You don't mention HIV testing, which ought to be done. From a risk standpoint, I would not have even recommended this, let alone PEP. But since you are worried and PEP was given, obviously you should follow up to confirm the expected negative results. You should be in touch with the prescribing doctor about exactly what tests to have and when. You can definitely expect negative results.

I hope this has helped. Best wishes--  HHH, MD


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36 months ago
Dear Dr. Hunter Hansfield, 

Thank you for your words of encouragement. I have been a little bit of a train wreck worrying about this. Sounds like the risks are astronomically low. I really appreciate your insight into this situation. I was able to breathe a little bit of a sigh of relief with your response. In regards to the PEP I was put on... The physician I saw made it optional for me. I chose to use it. Is there strong evidence that PEP works very well or is it all theory? Thanks again for your feedback. 
 
36 months ago
Dr. Hunter Hansfield, 

Is it still possible to contract stomach bugs, the flu, and the common cold while on PEP and afterwards? 

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
You had a very conservative doctor. As noted above, I would have counseled against PEP even if you had requested it.

PEP works very well; if you really had been exposed, it would reliably prevent an HIV infection from taking hold.

And of course it is possible to contract other viruses while taking PEP and afterwards. The PEP drugs have no effect on any viruses or infections except HIV.
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36 months ago
Dear Dr. Hunter Handsfield, 

Thanks for all your feedback. Sounds like this is most likely a case of ain't no way, ain't no how. Whatever sensations or symptoms with my stomach, nausea, or whatever is almost definitely not related. Because of the sporadic nature of it as well, it likely isn't connected. 
36 months ago
Dear Dr. Hunter Hansfield, 

My last question for you... Would PEP delay seroconversion illness or acute retroviral symptoms? I have lost a little more weight today. The doctor I saw last night feels I might be having a bout with a light stomach bug going around Denver. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
36 months ago
Your doctor probably is right about your current symptoms, and in any case nausea or other gastrointestinal symptoms are not likely due to ARS.

It is logical that if PEP fails, ARS might develop in the next 1-2 weeks after completing treatment. However, to my knowledge this has not been systematically studied. In addition, blood test seroconversion also probably is delayed. This is one of the main problems about using PEP, especially when it wasn't necessary to begin with:  because it delays definitive test results, it prolongs the period of anxiety until the patient can be certain s/he wasn't infected. That's an acceptable trade-off for a real exposure, but in my judgment not worth it when there is virtually no chance of infection anyway. However, to my knowledge there are no official guidelines on which tests and timing. My sense is that if blood tests remain negative (e.g. duo/4th gen at 4 weeks after completing PEP, or PCR at 10 days and antibody negative at 4-6 weeks), those results would be conclusive. But you should follow up with the doctor who prescribed your PEP, or another HIV/AIDS or infectious diseases specialist, for personal advice about it.

In the meantime, you can go forward with certainty you weren't infected. If I were in your circumstances, I would never have even been tested and would have continued unprotected sex with my wife without worry I could infect her. I suggest you do the same, even while you wait for final test reslts.

That winds up this thread. I hope the discussion has been helpful. Best wishes.


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