[Question #4746] Blood Draw Hiv /hepatitis Risk

28 months ago
In hindsight , I went for an unecessary Hiv test at a busy public  hiv clinic in a developing country in the southern Caribbean . The doctor used a butterfly needle . She opened the package in front of me , the plastic part of the package was face up , however when she opened it , I saw a brown spot on the paper side of the package . I didn’t think of anything at the time , but then I thought supposed it is dried blood.
Is it possible for blood to seep through the package and contaminate the needle?

I did a full medical 28 days after the test at a private laboratory that is iso certified, bilirubin was slightly elevated  . 4th generation hiv test came back negative . At 34 days I did a hiv 1 viral load and hiv 4th gen , both came back negative. Do I need to keep testing for hiv 1/ hiv 2? 


Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Welcome to our Forum. I'll be glad to comment.  I do not know what caused the brown spot that you saw on the paper side of the butterfly needle package but it does not sound like blood.  Even if it was, it is statistically unlikely that it would be blood from a person with untreated HIV and finally, even if both of those unlikely scenarios were the case, HIV present on a dried blood spot would be non-infectious.  I am confident that you had nothing to worry about.

In addition, with your tests, you have now PROVED that you did not acquire HIV.  Your 28 day 4th generation test would have detected more than 99% of recent HIV infections.  Subsequently your repeat test and a negative HIV viral load test provide conclusive proof that you were not infected.  You can be entirely confident that you did not acquire HIV 1 or 2 from the event you describe.  there is no need for further testing.  

I hope this information is helpful.  EWH
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28 months ago
Thanks Dr. Hook for your response. 
The reason for my paranoia, anxiety, ocd , is the vast majority  of patients , the  clinic  treats have  hiv, some of whom, do not have suppressed viral loads . The few  other patients without hiv are those  on pep, or those suffering needle stick injuries etc . I only went , as the private lab I go to, ran out of testing kits . The butterfly needles are stored out in the open , for easy access for blood draws . While it sounds improbable , that is was blood, maybe the package was dirty, any risk blood can seep through those airtight package ?

While I believe I am  pretty clear for HIV 1 with both viral load and 4th gen test. I have a  little concern for HIV 2.  

The country does not know if we have patients with HIV 2. There are some patients of the clinic who have HTLV1 coinfection . We also tend to get a lot of immigrants from other Caribbean islands , Latin America , some Nigerians due to our country’s wealth. Is the 34 day test conclusive for hiv 2? I have seen on the forum that you have recommended 6 week or more . If so , should I take a final test, and when ? 

In terms of hepatitis, any risk ?
Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Thanks for the additional information but none of this changes my opinion in any way.  You clearly do not have HIV-1.  As for hiV-2, given the circumstances, you are far more likely to be struck by lightening than to have HIV-2.  For the test to ab absolutely conclusive I would wait until at least 6-8 weeks but, having said that, I remain confident htat you did not get HIV-2 from the event you describe.  Please don't worry.  

No, no risk for hepatitis. Really.  Please don't worry. EWH
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28 months ago
Dear Dr Hook,
Thank you for your reassurance and advice  . I know HIV -2 is rare in the Americas and I agree with your assessment. Luckily I have never been struck by lightning, and I do not plan to ever be. 

On the island there are  about 11,000 people with HIV . The clinic treats the majority , I am not sure the breakdown of hiv 1 vs hiv, 2 but I am sure , like in other parts of the Americas , HIV -2 is a minority. 

 I have just  been suffering anxiety however, as my intuition that day, told me not to go to the clinic and do the blood draw, and I should have just listened to my mind , so I would’nt be in this predicament . 

I have listened to your advice and waited for the 8 week mark , and went on the 58th day following the event , to do a follow up test.
The test I did was a 4th gen test antibodies to hiv 1 and hiv 2 and antigens (p24, env-10, env-13, Al). 

1) Does this test pick up antigens for hiv -2 as well?
2)Is this 4th gen test as accurate/ modern as what you use in the US?
3) I know different people develop antibodies at different rates, and I have been under severe stress and anxiety ,and I know medicine is never exact,  but can this test I did, give a conclusive result for hiv2 at 58 days from the event?
3) I also know not much is known about hiv-2 in the Americas, and its window period, if the answer to question 2 is No,  given the test  I am using , should I do a final retest at the 12 week mark per WHO recommendations ?

Thank you again for the work you do. I know I am pretty much in clear , just want to be sure.


Edward W. Hook M.D.
Edward W. Hook M.D.
28 months ago
Yes, you are in the clear and you can now move forward with confidence.  In reference to your final questions:

1) Does this test pick up antigens for hiv -2 as well?
No, there are no tests for HIV-2 antigens, just the antibodies however by 8 weeks, had you acquired HIV-2 your antibody test would have been positive.

2)Is this 4th gen test as accurate/ modern as what you use in the US?
Yes, have confidence in your test.  Decades ago there was nation to nation variation in HIV test performance but that is no longer the case and similar 4th generation tests are used in the U.S. and worldwide.

3) I know different people develop antibodies at different rates, and I have been under severe stress and anxiety ,and I know medicine is never exact,  but can this test I did, give a conclusive result for hiv2 at 58 days from the event?
Yes, 8 weeks is beyond the range in which antibodies would have been formed, irrespective of your stress and anxiety.

3) I also know not much is known about hiv-2 in the Americas, and its window period, if the answer to question 2 is No,  given the test  I am using , should I do a final retest at the 12 week mark per WHO recommendations ?
The answer was yes- have confidence in your test results.  Time for you to move forward without continuing concern.

As you know, with this 3rd response, as per Forum guidelines, this thread will be closed shortly.  I hope my comments have been helpful and you will now be able to move forward.  EWH

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