[Question #798] scratched and cut - hiv transmission risk

84 months ago
Dear Doctors,

Whilst talking to someone, they grabbed my arm and scratched me with their nail. The scratch resulted in a small abrasion which bled minimally and has now scabbed over. I wouldn't think much of it except for the fact that this person had been scratching at their own irritated pimples prior. Worst case scenario, they have some blood under their fingernails and have then scratched and cut me, is this a possible transmission risk for HIV? When I considered PEP I was told this was a non-event. 

I would be interested to hear your insights as I can't find much else on this scenario on the internet. 

Thankyou
H. Hunter Handsfield, MD
84 months ago
Welcome to the forum. Thanks fo ryour question.

This was absolutely no risk for HIV. PRobably nobody has ever been infected by this sort of exposure. The world's busiest HIV/AIDS clinics and all HIV/AIDS specialists never have patients who were not exposed in the traditional way -- sexually, shared injection equipment, born to infected monthers, etc. It probably is unlikely the person had HIV, but even if s/he did, you were not at risk.

In other words, I agree with the person who advised you about PEP. You should not have PEP and shouldn't even be tested for HIV, if this is your only potential risk.

I hope this has helped. Best wishes--  HHH, MD

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84 months ago
Hi Dr Handsfield,

Thanks for your response. I was wondering if you could provide me with why this exposure is not a possible transmission vector for HIV? Everytime I think of the possiblity of dried blood under their fingernail scratching and breaking my skin (like I said, it bled minimally but did scab over a day or so later) I get very anxious. Wouldn't this count as blood to blood/mucuous mebrane exposure? I can't find much information on the internet relating to a scenario like this other than over generalised statements such as 'hiv dies upon exposure to air'..so any possible insights you could provide would be greatly appreciated. 

Thank you for your time
H. Hunter Handsfield, MD
84 months ago
The biological reasons are pretty complex, but they come down to survival of the virus in dried blood or secretions, and that infection doesn't take hold unless large amounts of virus have access to certain kinds of cells. But the biological reasons don't matter. The fact is that nobody has ever been seen with HIV whose only known exposure was a scratch. Even the busiest HIV/AIDS clinics virtually never see any patients who did not have the traditional high risk exposures (unprotected sex, shared drug injection equipment, etc). From the very earliest days of the AIDS epidemic in the early 1980s, public health officials were able to reassure the public that non-intimate contact didn't transmit the virus, because there simply are no infected persons without more intimate exposures. Simple logic which has stood the test of time.---
83 months ago
Thanks for elaborating on your response Dr Handsfield, it is much appreciated in easing some of my concerns. My final question is, to your knowledge do small cuts and scratches provide direct access to the bloodstream? 

Thank you again, this is a much valued resource. 
H. Hunter Handsfield, MD
83 months ago
"do small cuts and scratches provide direct access to the bloodstream?"

LIttle if any, and as already discussed, there is little if any risk of HIV from cuts or scratches. To avoid HIV your entirely life, have only safe sex and don't share drug injection equipment with other people. Beyond those things, don't worry and don't take precautions designed to prevent HIV.

That completes the two follow-up comments and replies included with each question, and so concludes this thread.

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