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occupational needle sticks
Dec 11, 2006

I was stuck by a needle of an hiv patient with a 670000 copies/ml hiv1 rna by pcr. the needle was very small it had been used to give her a shot of neupogen in her left deltoid. i had on gloves but i did feel the needle pierce my skin while it was being placed in the sharps container. the er doctor prescribed me kaletra 133.3 mg/ 33.3 capsules two tablets twice a day and truvada one tablet daily. i have taken my first dose this exposure happen less than 24 hours ago. on my er discharge papers it talks about zdv reducing the transmission of hiv by 80% and the cdc recommending this with two other anti-aids drugs. why wasn't i prescribe zdv or should i be calling the er and asking for a prescription. the patient was on antivirals but i do not recall the names. (also i did bleed my finger after the exposure and washed with soap what is my risk?)

Response from Dr. Wohl

It is true that the data we have on PEP (post exposure prophylaxis) mostly deals with AZT. However, there is no reason to think that a very potent combination such as Truvada and Kaletra would not be as, if not much more, effective. Current US guidelines sanction teh regimen you are on. It could also be that the source patient has a history of AZT treatment and/or resistance. This would further motivate the use of PEP that would be active against AZT resistant virus.

The risk is a function of the inoculum (size of the needle, bore, viral load of the patient), and the depth of penetration. That you started therapy quickly is a plus. In general, the risk of transmission without PEP is about 1 per 300 needle sticks. I suspect your risk is much lower.

DW



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