[Question #412] hiv risk during hiv test

92 months ago
hello doctors 10 days ago i had a HIV test in a very reputable lab in Rio de janeiro, Brazil , the phetolobomist show me the needle was new and i also saw that she was using new gloves , i was looking carefully to the needle than i saw the green plastic tray where she bring the vacutainner tube , i saw some red substance inside that i believe it was blood i cant tell it could have beeing something else i dont know why i didnt ask at the moment , but later when i came back she said that could not have beeing blood i said that there was something red inside that look similar , she said that could have beeing the red marker that she uses , i ask if it was iodine  she said that they dont use it . i became extremely afraid because that was a gentlemen there before me like 5 minutes  and im thinking the vacutainner tube could have touched contaminated blood , i know it is unlikely that blood would touch the part that would be punctured by the needle but if that happened , i was at risk of HIV infection ?i have asked two doctors one actually a resident , the first one said there was no risk as the needle was new , the resident in the ER was a very young woman and she said to me that she have no ideia about hiv or how the vacum tubes for blood draw work , than she recommended me to go to the infectious diseases hospital (the only one in Rio de janeiro ) to get pep . i didnt went because i thought she had no ideia what she was saying . i trusted the literature that says that hiv is never transmited by blood draw unless the needle is not new .now i have lost the chance to take pep . im having alot of ars symptoms my throat is a litlee sore but the worse is that im having pain in my bones and muscles specially in the shoulder and neck sometimes all over the body maybe im very tense and anxious .here in Brazil we dont have STD/ hiv counselors so i need your help , what would be the risk if infected blood touch the part of the vacum tube that would be pucture by the needle?
H. Hunter Handsfield, MD
92 months ago
Welcome to the forum.

Some questions can be answered accurately based on nothing more than the title of the question. That probably is the case here. It is probable that nobody in the world has ever caught HIV from having blood drawn, at least not in the past 30 years since people stopped re-using unsterilized needles.

Now I have read the question. Nothing in it changes anything. There is no way infected blood would have come into contact with the equipment used to draw your blood. The ONLY way you could have caught HIV from this event is if the same needle had just been used on an HIV infected person, which certainly did not happen. You are seriously overreacting. I'm sure the resident recommended you go to the infectious diseases hospital not because she believed there was a risk, but because you were irrationally anxious and she wanted to refer you to an expert for reassurance. ARS doesn't cause the symptoms you describe, unless other typical symptoms also are present (sore throat, fever, skin rash, enlarged lymph nodes). Your symptoms are typical for the physical manifestations of anxiety.

My advice is to stop worrying about this. I hope you are able to do so. Best wishes--

92 months ago
thanks for the answer Dr Handsfield and apologize my english mistakes , i was thinking that this would be your answer as i have read similar questions in another web site where people use to send questions to you some were similar to mine , but none of this questions where exactly like mine they were about people with fear to contract hiv by blood draw because of dirty needles , cotton with blood or wherever in my case if there was blood it was only inside the plastic tray . you said that there is no way blood would come in contact with equiment used  , only the vacuteiner tube was in the plastic tray/basket so only the vacutteiner tube could have touch blood  , after the blood draw she show me the tube to check my name on it and i didnt notice any blood on the tube  . the rest of the equipment the  needle  , gloves and cotton the phelebotomist took from a separeted cabinet , she opened the needle in front of me i made sure i saw it . the symptoms have  worried alot but they mostly dissaperead after i receive your answer and other doctor answer im still felling a litle pain in the back because im still a litle tense but i believe the pain in the neck , shoulders and other parts of the body was caused by stress and anxiety . i was using a cream called triamcinolone acetonide 1 mg because i was bitting the inside of my cheecks and was hurting really bad , that caused me some stomach/gas problems because i have swallow alot but im unaware of the side effects of this medications .  my family is very conservative christian family and my wife is also , she married virgin and nobody will believe me if i get hiv from  blood draw/test they will think im lying , just giving the reasons for me to be so anxious doctor . sorry  but i have 4 questions to ask you.
1-Is it possible for blood if present in the plastic tray to get inside the vacuttainer tube and touch the part of the needle that is inside the tube and would hiv if present would be viable to infect  ?
2-the vacutainer system can suffer a error and first inject and after draw ? i suppose that would be dangerous even if no blood were present .
3-my test was negative it was a 4 generation if infected hiv blood had contamineted the sample , it would have come back positive ?
4- 10 days is too early for ars ?
sorry to ask you this questions doctor but im trying not to have sex with my wife for the last 10 days even kissing im kissing her closed mouth because i have venners in my front teeths and sometimes it bleeds  im afraid she will start to realize something is wrong so i want to make sure im not gonna infect her or anything as she is a very pure women .
H. Hunter Handsfield, MD
92 months ago
HIV is much harder to transmit than you seem to think. Like a lot of people, you assume that any exposure at all is risky, as if "just one virus" is enough to transmit. Not true for most infections, and definitely not HIV. Large amounts of virus must come into contact with specific kinds of cells which typically are deep inside the body, or must get directly into the bloodstream. The events you describe in a lab do not meet those critiera. As an example, if infected semen is desposited inside a woman's vagina, the average transmission risk is once for every 1,000 exposures.

1) No, probably not possible.

2) The vacutainer system is designed to prevent this. It doesn't happen. And anyway, it would also require using the same needle on more than one patient, which never happens.

3) I doubt that enough blood could contaminate a specimen by this mechanism to cause a positve result. But your result was negative, so this seems an irrelevant question.

4) ARS symptoms usually start 10-15 days after exposure. As I already said, your symptoms are not suggestive of ARS.

Any HIV risk to your wife would come only from whatever exposure you had that led you to request HIV testing. The test itself is a silly reason to consider holding back on sex with her.

Your thinking on all this is very abnormal. Do you have OCD by any chance? That's what it seems like. Anyway, people with normal psychology and thought processes do not have worries like this. If it remains an issue for you, counseling might be in order. I suggest it from compassion, not criticism.

Good luck and best wishes.

92 months ago
Hello Doctor as this will be the end of this thread i will clarify all my doubts , as you have asked i do have OCD but its related to numbers i do not have extreme fear of hiv i always read about people with fear of hiv from enviromental surfaces and i found this fears to be unfounded or ridiculous i hope i dont get on this path it is something i will definetely talk with my therapist about .
i didnt have a particular reason to order a hiv test my last hiv test was when i got married about 10 years ago and i have not had any risks im in a monogamous relashionship  , i never had a blood transfusion , i never used drugs and only drink socially so i guess  im the lowest risk you could possibly imagine the only theoretical risk i could imagine was kiss women in the lips by mistake because here in brazil we kiss woman in the checks when we meet a friend or even someone that you barely know and sometimes as this happens many times daily i have kissed couple womans in the lips (closed mounth , during the years) that last for a second im pretty sure that is not a risk also i had shacked hands with people sometimes with cuts and nicks in my hands well than im just showing that i never had any risk for hiv at least not that i can imagine but my phsycian told me that would be a good ideia to get a hiv test anyway as i have not had one for a very long time i honestly thought to take this hiv test was a dumb decision but as i like my phisycian a lot i decided to get one as it would be paid by my health insurance and it would cause no harm . 
i actually know hiv is very dificult to get it have to infected cells deep into the tissue or get acess direct to the blood stream well that actualy what scared me , you said that the events in the lab to not meet those criteria , but they do have acess to my blood stream during a blood draw as they go directly into my vein .

Well i guess what i should have asked is what concerned me most is that : 
1 -blood on the plastic tray if present could have entered the vacutteiner tube  then touched the needle part that goes inside the tube and somehow inject infect blood ? i guess your answer will be no  or 1 chance a in a billion ?

2 -Do you believe if i had went to the infectious disease hospital they would prescribe me pep ?

3- if i dont get to move on with my anxiety a 4 generation test would be conclusive at 3 or 4 weeks ? i know you will say that test again will be dumb or silly as it was not a risk but if anxiety doest go away i will have to do this .

4 - have you ever heard of someone who contracted hiv during a blood draw ? brazil is not a developed country but a country in development but i guess that would not change anything as the facility i went to was similar to the ones in the US or europe and they only use disposable equipament .

5-do you think i should file a complaint with the lab that i got the test about blood on the tray or this is irrelevant as i dont even know if that was really blood ?

and as you have adviced i will definetely talk with my therapist about this particular incident and if he thinks this could be somehow the beggining of a obssesion about hiv or not , i hope this was the only incident and wont repeat again . what have worried me was symptoms but that was probably anxiety , stress and bad sleep habits .

thanks for the help and happy new year to you as i forgot to say before .

H. Hunter Handsfield, MD
92 months ago
As for all with OCD, there is always another question. It's part of the disease, and this is what I see in these questions.

1) It's unlikely blood would get on such a tray, and I cannot imagine how it would then get inside a vacutainer. If it did, there still would be no risk; vacuainters are designed to prevent it.

2) Of course not. No doctor who understands HIV would be willing to precribe PEP in this istuation.

3) The 4th generation tests are conclusive any time 4 weeks or more after exposure.

4) Already answered. See opening comment in my original reply.

5) I see nothing to complain about. You give no evidence they followed impropoer procedures in any way.

That concludes the two follow-up comments and replies included with each posting fee, and ends this thread. Please do not post a new question about these events and HIV risks. Repetative questions are not permitted and you would risk having the quesiton deleted without reply, and without refund of the posting fee. If you find yourself continuing to obscess about this, professional counseling should be your next step.

Best wishes and happy new year.