[Question #718] Pep

53 months ago
Hi, 
I'm a police officer and me and my colleague was responding to a call of a male being suspicious around some public toilets. When attending the male he  was shooting up drugs in his arm , when we approached the male he tried to run and in the progress of obtaining him he stab the needle in my arm. Within 2.5-3 hours after this incident I was given pep Tenofovir 245
Raltergravir 400. I'm on day 2 and have to go back on Monday for the additional tablets. Since this I have been in a right state very angry and worried! I have been asking and looking up info, and my question is: is pep effective and in your professional opinion has anyone got HIV after the 4 weeks on pep? And also is there a high risk I've getting HIV from getting a needle in my arm? Again read there has to be a bit of blood and especially in a vein! Sorry for the long question. Many thanks 
53 months ago
And sorry forgot to ask are the 2 pep medications the right ones as I've been reading up and other recommend other ones?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
This is a revised reply. If you saw the orginal one, please re-read this. The first time I misread your question and somehow believed your assailant is known to have HIV. Apparently that's not the case. So here is my entire reply, re-written.

Welcome to the forum. Thanks for your question. I'm sorry to hear of your situation -- this is a tough deal to be going through and I understand your concerns. I'll try to help.

If your assailant has HIV, this obviously was a high risk exposure, and until you know, it is right that you were prescribed post-exposure prophylaxis (PEP). I'll add at the outset that it is likely that the doctor who prescribed it has more experience with HIV exposures and prescribing PEP than Dr. Hook or I do. To my knowledge you are being treated with the best PEP drugs. However, if your doctor is not an infectious diseases specialist or otherwise highly experienced in managing and preventing HIV, you should ask for referral to such an expert to assist in your management.

From research in animals, PEP is believed to be virtually 100% effective, especially when admininstered within 24 hours. In addition, the large majority of HIV and infectious diseases experts have had no patients in whom PEP failed to prevent HIV. (As you will understand, it isn't possible to do research in humans who are known to be exposed, i.e. to treat some but not all with PEP to learn its true effectiveness.) I cannot say whether "anyone" has acquired HIV after PEP, especially when administered this quickly. However, most experience is in people with much lower risk of infection, such as sexual exposures. Whereas unprotected sex typically has less than 1 chance in a thousand of transmitting HIV, the risk probably is a lot higher after an injection exposure like yours. To my knowledge, there are no data on which to put a percentage estimate on your risk. While it is probably true that direct injection of infected blood into a vein is the most efficient mode of transmission, a needle stick under the skin may be almost as risky. For the rest of my reply, I'm assuming the needlestick was definite -- i.e. there is a clear entry wound, i.e. not mere suspicion that you you might have been stuck.

But of course you don't yet know whether he has HIV. Even in the highest risk urban areas, the large majority (over 95%) of injection drug users are not infected. If not, you can safely discontinue PEP; presumably that's why your initial prescription was for only the first few days. If he claims to be HIV negative, he still should be tested immediately. In this situation, I would recommend he have a PCR test (to check for viral RNA) as well as a duo test for HIV antibody and antigen. If he refuses voluntary testing, most or all states have laws that provide for court ordered testing in this situation -- but of course I do not know the legal situation in your area.

Even if it turns out he has HIV, at least two aspects are strongly in your favor, and maybe a third. First, your PEP was started very promptly. Second, the amount of blood in or on the needle probably was very small; the dose of virus makes a big difference in transmission risk. (Your situation is analagous to that of health workers who sustain sharp instrument injuries with HIV contaminated needles, scalpels, etc. Even without PEP, the large majority do not become infected.)

Third, if he is HIV positive positive you should also your assailant's detailed HIV status. Is he in medical care and on anti-HIV treatment? What is his viral load? As for HIV testing itself, most likely there are legal ways to learn this information even if he doesn't cooperate.

All in all, the odds are strongly in your favor, first because he probably doesn't have HIV; second because the risk might be quite low even if he does; and third because of prompt PEP. However, you also need to be asking these questions of the doctor(s) treating you, ideally an HIV/infectious diseases specialist.

I hope this information has been helpful, but let me know if anything isn't clear. Best wishes and good luck--  HHH, MD
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53 months ago
Thanks for your reply doctor, just really worried as I have a wife and kids and this would ruin my life if came back positive! All I know is it was one of them small needles that was stabbed in my tricep! Just really wanted to know if you have known and situations where pep hasn't worked especially  to do with needles and how long does the virus survive etc 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
I already said I don't personally know of any patients win whom PEP didn't work. The answer to your fears and anxieties is to continue to work with your doctors. You might consider printing out this thread as a framework for discussion with them. As I said, the odds are strongly in your favor. Good luck.

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H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
I asked Dr. Hook to take a look at this discussion. He agrees with everything above, and feels you are on exactly the right PEP drugs. He also points out the importance of taking the PEP meds exactly as prescribed. Most PEP failures are due to the patient's failure to take the medications as directed. So hang in there until and unless a qualfied expert says you can safely stop.

I hope things are going well.

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52 months ago
Thank you for replying back hope it works 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
What you should be hoping for is that your assailant does not have HIV. If he doesn't, no worries! I assume you and your doctors are addressing this and making sure he gets tested, right?

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52 months ago
Yes they are if he is do you reckon my chances are high of getting it?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
52 months ago
Already answered. Carefully re-read my original reply above.

There is a limit of two follow-up questions and replies. No more until you report the result of your assailant's HIV test. After that the thread will be closed.


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51 months ago
Hi dr

I went for a follow up blood test 18 days after the incident I had as we discussed before, it came negative but is 18 days after pep to early for a conclusive result? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
51 months ago
If that was a duo (combo) test, it's about 90% conclusive. It takes 4 weeks for a truly conclusive result. But I have never heard of a patient in this situation who turned out to have HIV. You can expect any further tests to remain negative.

That ends this thread. Please do not start a new thread with further questions about this event, test results, etc. In the meantime, stay relaxed and do your best to stop worrying.

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