[Question #5386] HIV+ hospital exposure?

75 months ago

Thank you for the service you provide! I've read through many of your answers, and it's helped put my mind somewhat at ease. But, like many of the posters here, I have some lingering anxiety about my experience. I've sought counseling, but also would like some words from an experienced professional to help mitigate lingering doubt.

I am a nurse, and was exposed to HIV+ blood 7 weeks ago. I was taking blood from the IV line of a noncompliant, HIV+ patient with a high viral load for labwork. Some blood from the syringe I was using ran into my gloved hand, and some of that blood ran onto my exposed wrist. I quickly washed my hands and wrists, but discovered a scratch in roughly area where the blood was when I dried them. It looked like a partially healed scratch from my cat. It was not a fresh scratch from the incident, and did not sting when I put alcohol on it. I did not report the incident or seek PEP because I did not consider this a particularly threatening exposure.

Two weeks later, I found pink spots that looked and felt like ingrown hairs on my palm. Four weeks after the incident, I found a rounded scab on my hip, and another like it on my right buttock. I have never gotten spontaneous scabs like this before. An Alere determine test at 4 weeks was negative. The next week, I got another round scab on the back of my left arm, and what looked like a mole on my right forearm that scabbed over on its own in a few days. Not trusting the instant test and worried about persistent lesions, I tested again with a blood draw at 6 weeks which was also negative. I wanted to trust the result, but more pink spots appeared on the palm of my hand days later. The scabs are gone now, and left pink, palpable scars.

I know your stance on testing, but are these skin abnormalities worrisome? I respect the science, and would also request a link to the review article that made you reconsider 6 weeks vs 4 weeks for definitive results. Thank you again for your time!

H. Hunter Handsfield, MD

75 months ago

Welcome to the forum. Thanks for your question, and for reading other threads with questions like yours.

First comment: Even though you correctly considered this a low risk exposure, it still would have been best to have informed the infection control personnel at your place of work. They undoubtedly want to know about all potential exposures to blood borne infections. And it is probable they have much more experience managing situations like this than we do on this forum. You might still want to discuss it with them for further reassurance. In addition, they will want to review your procedures with an eye to preventing similar events by your colleagues in future.

That said, this was a zero risk exposure and I'm sure they would have agreed you did not need PEP. Even if it were a risky exposure, a negative blood test at 6+ weeks always overrules exposure history and symptoms. You could have mainlined HIV posiitve blood: the test tells the truth. And because the current HIV blood tests are so accurate (beyond a few weeks after a potential exposure), they also overrule any and all symptoms. The "pink spots" on your palms or elsewhere are proved by the test not to be due to HIV. (And HIV is not a likely cause of any such rash anyway.)

Here's the recent review of HIV test performance, on which we base our advice that 6 weeks is preferable to 4 weeks for conclusive HIV AgAb (4th generation) test results: https://www.ncbi.nlm.nih.gov/pubmed/29140890 The same issue of the journal also had an accompanying editorial from CDC, supporting the conclusions.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD

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75 months ago

Thank you for your quick reponse! I posted the question after a long night shift, and woke up to the answer. Too awesome!

You're very correct I should have (and need to now) report this sooner, especially with the uncertainty. I was afraid I broke protocol or might face repercussions, which added layers of guilt to my feelings of fear. I need to come forward to my institution to completely put this thing behind me.

I got tested at a facility that offers FREE HIV testing to anyone. They're great! I plan on seeing how I can use my RN experience to volunteer with them and use this to have more empathy with my patients... As well as have a deeper respect for how careful I need to be around infectious diseases in the future.

Sorry if this is long-winded! Appreciate the article, read every word. Two more questions, if I may:

Do 4th gen tests pick up active infections, ie during seroconversion symptoms?

Would an acute HIV rash even appear in different sites over the course of 3-4 weeks?

My suspicion is the answers are yes and no, respectively. Just curious! Thanks again!

H. Hunter Handsfield, MD

75 months ago

Performance of all HIV blood tests, including AgAb (4th gen) depends only on time since infection, totally unrelated to presence or absence of symptoms. If negative 4 weeks (always by 6 weeks) after exposure, symptoms don't matter. HIV rash never is the only symptom of a new HIV infection, only in conjunction with fever and usually other sy mptoms like pharyngitis, lymphadenopathy, etc; and never localized, always body wide; and certainly not migrating around as you desribe. (Never look at lists of HIV symptoms with an eye to diagnosis, either self-diagnosis or in patients. Always useless, because every one listed is nonspecific, i.e. common to many problems in addition to HIV. Only the pattern of symptoms and exam findings is potentially important in diagnosing or suspecting acute HIV infection.)---

75 months ago

Good to know! I rely on Google so much for finding recipes, the best route to work, what the weather will be, etc. that the first impulse was to lean on it for finding out whether or not I was amidst a life-changing diagnosis. Ultimately just paranoia fodder and hearsay in this situation. But hey, it helped me find this site! Thank you for the work you and your colleagues do. Have a wonderful week!

H. Hunter Handsfield, MD

75 months ago

Thanks for the thanks; I'm glad to have helped. I still encourage you to discuss this with your infection control folks. They'll want to know -- and probably wouldn't be painful or embarrassing. Properly trained infection control nurses etc typically are very understanding and sensitive to the personal issues that influence these things.

Best wishes.

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