Hello doctor,

First of all I highly respect the work you’ve done on this site and HIV-related research. It truly helped a lot people.

Background:

I haven’t had sex for more than half a year, but always have the fear towards HIV. It gets especially bad in the recent a few weeks. My hand was poked by a sharp object in a clinic a few weeks ago after a urine test. The wound bled a bit. Since it was in a clinic and I wasn’t able to identify the object and how did the injury happen, I became worried of HIV. I went to a clinic to ask for PEP, at which two nurses refused to prescribe and told me it was a negligible risk. However, due to my compelling nervousness at that moment, I insisted to take it. (Truvada + Isentress)

What Happened:

During day 19 on PEP, my skin felt itchy. It alerted me to ARS. I went to a clinic to get a rapid test using Alere Determine Ag/Ab test. Two of my fingers was poked to extract blood and the nurse pressed the wound very hard, but the test was negative. About 2-3 hours later, I went home and took off the bandage as the wounds were no longer bleeding.

Then I took out the raw beef I bought from a grocery store and started to cook. While cutting the beef, I noticed some beef blood on the tray. I used the hand with the wound to hold the meat and the other hand to cut. I felt a little painful on my wounds and switched to different fingers to hold. Later on, while I was cleaning the wounds with alcohol, it gave me an immediate burn (indicating the wounds were still open).

Reactions:

After dinner, I knew my anxiety got triggered, because I could not get away with the thought that what if the butcher has HIV and cut himself while slicing the meat and his blood dropped on the meat. (The beef has a label saying it was hand trimmed.) 

I know it may sound a little crazy, but the meat was in the fridge (not freezer) the whole time, meaning the virus can be preserved. Additionally, the surface was still cold and wet (to stay fresh), which sets the perfect environment for virus to survive. From that standing point, the fact that my wound touched the beef surface and its blood stresses me out. I know this might be a bit paranoid, but I found it difficult to calm down. That’s why I need your expertise. There is also no way to know whether the butcher had cut himself or not.

Questions:

1.          Please assess both of my exposures (they both give me anxiety);

2.          If we suppose there are virus on the meat, how much chance I could get infected?

3.          The finger cut happened on day 19 of my PEP usage. Does it provide any protections for the second exposure?

4.          Should I prolong the PEP regimen after the 28-day dose? (I asked this question because PEP is given for 28 days to an exposure.)

5.          When can the test result be considered as conclusive?

Please use your knowledge and expertise to help me, doctor. I really appreciate it.

Thank you so much for your previous response. I've been trying to respond to my anxiety.

Here are a few updates:

1. My provider decided not to extend my PEP session for he thought the nature of the 2nd exposure (wound touching hand-trimmed meat) carries very low risk and PEP also offers some protections. However, the provider recommended PrEP (Truvada) to me. I decided to make the transition to PrEP.

2. On day 23 of my PEP(Truvada + Isentress) use, I bought a bottle of juice. I had some before I took Isentress. Only after a few days did I notice the juice contains 70 mg magnesium. According to a UCSF’s HIV InSite website, it says co-administration of Isentress and antacid containing magnesium within the 2-hour interval can reduce Isentress absorption by 50%.

3. Since your last response, I have reached out to a counselor and a psychiatrist, who prescribed Gabapentin and Escitalopram to me for my anxiety, but I was not diagnosed with any mental issues. I am hesitant to start the medication because I was concerned if any or both may have interactions with Truvada(PrEP).

4. I developed some itchy skin 2 weeks after I competed PEP (6 weeks after initial exposure; 3 weeks after I touched the raw meat with my punctured finger). I have also taken Truvada since the completion of PEP. The itchy parts mainly concentrate on my arms and legs, and lower chin, which also had some unusual bumps. I wasn’t able to identify rash because I never had one before. I was also tested at same week using 4^th gen Ab/Ag CIMA test and received a non-reactive result.

New Matter:

Yesterday, I accidentally scratched my face for a little bit and a small amount of blood came out. Approximately 2-3 hours later, I headed out to buy some dinner. As I was walking down the street, a small piece of saliva-like fluid (not 100% sure if it is really saliva) dropped on my wound from a building window. I immediately took out my hand sanitizer to clean the small wound, and there was a mild pain, which means the wound wasn’t entirely healed.

Questions:

1. Does Truvada interact with Gabapentin and/or Escitalopram?

2. Does the juice which contains 70 mg of magnesium, has any influence / could lead to any potential problems on my PEP regimen? (It was take close to my medication time but not whole bottle.) Do antacid that contains magnesium and magnesium in juice have the same effect on Isentress?

3. What’s the risk of my most recent spit-on-wound incident? Do I have to do anything about it? Just worried if there were blood in the spit, I may have to take some actions.

4. Are my itchy skin conditions potentially associated with ARS?

5. In your previous response, you mentioned the risk would still be ZERO even if there were virus on the meat. Can you please briefly elaborate a bit on this?