My boyfriend was puctured by a needle
Mar 20, 2003
Dear Dr. Kull, I urgently need your advise my boyfriend recently got into a physical fight with a homeless person who was threatening him. During the altercation my boyfriend's thumb was punctured by a needle. He went to a clinic but we have yet to hear the results, they also said that HIV can be undetectable for months after transmission. I am sick with worry and I was just wondering what are the odds that he contracted HIV and how long will it take to actually find out. How long can HIV stay alive inside a needle? I was hoping that you could put my mind at ease I don't know what to do. Sincerely, 21 year old female in California
Response from Mr. Kull
Exposures of this sort are unusual, so it's a difficult scenario to assess, but based on the evidence we have about accidental needlestick punctures, the risk for infection is very low. Transmission through accidental needlestick injuries is only known to occur in healthcare settings, and even in then the number of actual transmissions is really low (see below), so there should be little cause for alarm for you guys.
Before we dive into the reasons why the risk is low, you need to take some other issues into account. In order for your boyfriend to be at any risk, certain things need to be true: the homeless person would have had to have been infected with HIV, the needle in question would have to have been contaminated with the person's blood (syringes used for injection drug use are the most likely vehicle for transmission, and we don't know from your question whether or not it was a syringe used for drug injection), that blood would have to have been rather fresh (HIV dies rapidly as fluids are exposed to the environment and dry), and the puncture wound would have to have been deep enough to provide HIV access to his bloodstream. Some research demonstrates that HIV can survive longer inside a hollow-bore needle, but that is probably not relevant in this case, as there is no evidence that the exposure involved injection of any sort.
Transmission through accidental needlestick exposures is a rare event and limited to healthcare workers (based on data collected by the Centers for Disease Control and Prevention). The risk for your boyfriend getting infected (if the above criteria were true) would be similar, not equivalent, to a healthcare worker's risk during an accidental needlestick puncture; his risk is not similar to an injection drug user who shares needles for injecting drugs.
HIV transmission to healthcare workers does not commonly occur. One source estimates a .3% risk of HIV infection after a needlestick exposure to HIV-infected blood. Factors that might increase the risk of transmission are: depth of the puncture, size and type of needle (hollow-bore needles pose a greater risk), where the puncture occurs (vein and artery punctures are greater risk), and the viral load of the host. Punctures that produce spontaneous bleeding may pose a greater risk. A person who is in very early or late-stage of HIV disease is more likely to have a higher viral load, possibly increasing the risk to the person experiencing the needlestick injury.
If you add all of this up, there are a lot of factors that needed to be true for transmission to occur, and that means that the odds for transmission are tiny. Your boyfriend should continue to consult with healthcare providers to monitor the situation, and can get antibody tested three months after the exposure.
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