Hello Doctor Roberts I 'am a doctor in India and soon be finishing my USMLE.As i know the transmission and risk factors i share my experience with you because my case is a little different.While i was on the street a sex worker approached me and offered me cheap sex and i got little cranky and started hitting her as she abused me when i refused her offer while i was hitting her her bangles broke and pierced in to one of my fingure little deep and there was little blood that came out from the injury and my point is i don't know whether she also got injured and there was bleeding for her hand and my blood contacted her blood or not.after 12hrs post this incident i started zidovudine and lamivudine and got a antibody test next day which came out negative.now can you please advise me whether i should get a rna pcr done and continue prophylaxis?actually i don't know the hiv status of the worker.what would you advise me sir.i will be very thankful for your advise.

Hi,

I'm glad you found the correct forum in which to pose your question!

You hit the sex worker because she offered you cheap sex on the street??? Wouldn't a simple "thanks but no thanks" have sufficed? So you slugged Sally Sex Worker and buster her bangles, one of which pierced your finger. (That could be cosmic karma for smacking her!) You're worried the punched prostitute might also have been bleeding and therefore been an HIV-transmission risk? Dude, how much blood was flying around during this altercation? Unless it looked like a Quentin Tarantino film, I would say your HIV-acquisition risk was essentially nonexistent. PEP (post-exposure prophylaxis) was not warranted. I'd suggest you discontinue it. I would also advise against an HIV plasma viral load PCR RNA test. Not only is it not indicated; it would be unreliable as a diagnostic test, because you are actively taking antiretrovirals, which could drive the viral load to undetectable levels, thereby resulting in a false-negative PCR RNA test!

I would suggest you calm down. Get a single HIV-antibody test at the three-month mark to put any residual worries to rest. Finally, you might consider some anger management classes so that you'll be less likely to bloody up those who annoy you!

Good luck.

Dr. Bob