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occupational exposure from known hiv+ needlestick
Jan 19, 1999

Dear Dr. Holodniy,

A co-worker was recently stuck with a contaminated 20 gauge needle while drawing labs on a known HIV+ patient. The RN was wearing gloves and the stick was superficial (nicked the skin enough to bleed)and the area was bled and then washed with alcohol. Combovir was started within the hour and will be continued for 4 weeks. The patient's viral load is 1600, has renal failure secondary to the HIV status, but otherwise is asymptomatic at present. What is the likelihood of converting when all of these factors are taken into account? Is 1600 considered a low or high viral load? If the 6 weeks test is negative what are the chances of converting between 6-12 weeks? Thanks for your help.

Response from Dr. Holodniy

1600 would be considered low. But plasma viral load is only one component of blood that contains potentially infectious HIV. Blood cells are the other compartment. Despite estimates of over 600,000 needle sticks/yr that occur in the US, the CDC has only documented < 60 cases of health care worker seroconversion in over 10 years that was truly related to on the job exposure. This probably relates to the viral load, inoculum size, and recipient immune system. A look back study showed that AZT monotherapy started within 4 hours of exposure, significantly reduced HIV infection. It would be expected, although not studied, that combination therapy would be even more effective in preventing HIV infection. The likelihood of converting is very low. A negative test at 6 weeks is encouraging. I can't give you accurate numbers about seroconversion between 6-12 weeks. Testing should continue until 6 months.

MH



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