|Needle accindent, on PEP
May 2, 2006
Hi there, Student nurse from Europe here, currently doing a practical training in South Africa. Had a needle injury, the needle had been used moments before on an advanced AIDS patient. My collegue was sloppy disposing of the needle, left it laying around on the sheets of the bed. The needle punctured my gloves and skin, the wound was desinfected using ethylalcohol (70%). The needle had a medium sized diameter (i saw some guidelines on PEP where they distinguished between large diameter needles and small diameter needles from the PEP treatment point of view). I was put on Stocrin, lamivudine and zidovudine one hour after the accident, have to take them for one month. The side effects are quite something, but i'm managing quite well all things considered. The questions... What data is available on the effectivity of PEP if started soon? What is the risk for seroconverting by a needle accident, if the needle was used on an high-VL AIDS patient (when not on PEP vs on PEP)? Does the PEP work in case some resistance mutations are present in the virus? (the patient was not on medication, had never been, this is more a question rising from my deep interest towards hiv) ? Will the 3month Elisa be conclusive, or would you recommend a 6 month testing?
Thanks doctor, J
Response from Dr. Frascino
1. What we know about PEP is that the chances of it being effective improve the sooner it is started after the exposure.
2. In prospective studies of health care workers, the average risk of HIV transmission after a percutaneous exposure to HIV-infected blood is estimated to be 0.3% (95% confidence interval).
3. Depends on the resistance mutations and what drugs are chosen for PEP.
4. Current recommendations suggest testing out to six months.
I'll reprint below a question from the archives that references the full text of the latest version of guidelines from the U.S. Public Health Service and also the California PEP guidelines. These documents will further address not only your specific questions, but also your interest in HIV.
I'll send my best good-luck karma that your follow-up HIV tests are negative.
PEP - As mysterious as Bush winning two terms Oct 19, 2005
Thanks again for all the work and help you provide for your fellow man...A few questions. PEP...Why is the general population 'in the dark' about this..? If I know about it, would have started it right after potential exposure. Are there any statistics as to how it works, and how successful it is..? Why isnt it spoken about more in the "main stream" literature, etc.etc.
OK, I thought this would be a good topic for all who read... Time to celebrate with a few drinks, so thanks again for reading..? What is to celebrate, you ask.? Well, Tom Delay's indictment, which may continue to help bring the Democrats back in power.!.. S in Ohio (shhhhh it should go "blue" again as you suggest, in next election)...
Response from Dr. Frascino
Hello Ohio "Blue"-Boy,
Actually, I'm always amazed at how "in the dark" the general population is about HIV in general, and not only about PEP. Then again, our HIV awareness and education programs in the US are woefully inadequate and shockingly puritanical, which may account for some of the head-in-the-sand attitude, apathy and ignorance. Regarding the latest information on PEP, I'll reprint one of the many posts form the archives. Check it out! And spread the word! Tell your friends, write a letter to the editor, discuss it with your doctor, put a bumper sticker on your car, tattoo the information on your Mr. Happy, whatever . . . . Yes, DeLay gets two indictments in one week; Frist is under investigation; Rove and Libby won't be far behind. Ohio is now a lovely shade of robin's egg blue and will soon be as blue as the Mediterranean (which is exactly what I'm looking at this very moment)?
It's 2005...any changes ? Mar 14, 2005
In 2001 the experts said "The current recommendations state that persons with non-occupational HIV exposures should receive medical evaluations, including HIV antibody tests at baseline, 4-6 weeks, 12 weeks, and 6 months".
Has this window period of 6 months been shortened ? It's 2005 and i would like to know why the antibody testing technology have remained a stalemate and not improved.
It's like going into a coma in 1985 and waking up in 2005, only to find out HIV testing has not improved one little bit.
Response from Dr. Frascino
New U.S. guidelines for treatment of non-occupational exposure to HIV (n-PEP) were issued in January 2005. In addition, California also recently issued its own n-PEP guidelines. Yes, there are some changes from the original guidelines however, not in the duration of follow-up testing recommended. Both sets of guidelines continue to recommend follow-up HIV antibody tests out to six months. The full texts are available at:
1. http://www.cdc.gov/mmwr/mmwr_rr.html/ (for the US guidelines)
2. http://www.dhs.ca.gov/ps/ooa (for the California guidelines)
HIV antibody testing has gradually improved over the past 20 years. We now have 4th generation assays. That's not to say there isn't room for further improvement, but we certainly have moved farther than "one little bit." Hope that helps!
Of Chelsea boys, gels, and prohormones (not in that order)
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