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How 'fresh' does a 'fresh cut' have to be?
Dec 29, 2004

Hi Dr. Bob,

Well, I'll try to keep this brief. I was fisting this guy who has been positive since 1990 w/o a glove. I never got my hand in all the way but at one point when I removed it there was blood on my hand. It wasn't a lot of blood, but it wasn't just a few drops either. Also, there was a significant amount of a mucous-like substance on my hand.

I immediately washed my hands w/ soap and water. I saw no open cuts on my hand. There was a little red mark on my hand that was there prior to my contact w/ this guy but it seemed to be closed. However, there were dry cracks in the skin around my fingernails.

I flipped out and started taking antiretrovirals. I took my first dose w/in 2 hours of this possible exposure. I have been on the regimen for about 6 days now and I'll be honest, it's killing me, but I figure better to live w/ side effects for 30 days rather than the rest of my life.

So, I have three questions for you:

(1) How 'fresh' does a cut or opening have to be to be at risk of transmitting HIV through blood?

(2)What is the risk of transmission through this mucous-like substance I described?

(3)Based on what I've described, do you think I should continue w/ the ARVT?

Thanking you so very kindly,

'Flipping out'

Response from Dr. Frascino

Hello Flipping Out,

1. As a general rule, if blood isn't coming out of a "fresh" cut, then HIV or other blood-borne pathogens shouldn't be able to get in. This does not apply to mucous membranes, which can actually absorb HIV.

2. I really can't answer this, as I don't know what the mucous-like substance was. Lubricant? Anal cavity secretions?

3. Regarding non-occupational HIV exposures, it's best to consult an HIV specialist if possible. He/she will need to ask you a variety of questions to actually assess your level of real risk and then discuss the risk: benefit ratio of taking PEP. As you have found out, it's not as simple as popping a daily pill for a month. (If you think 6 days is "killing" you, just remember some of us have been taking this stuff everyday for over a decade!)

Finally, by now you've probably realized that the risk you exposed yourself to could have been quite easily avoided. I'm hopeful that by posting your experience, others will think twice and consider the consequences of their actions.

Good luck. I wish you a safe and healthy New Year.

Dr. Bob



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