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A few questions regarding needlestick exposure
May 19, 2006

I am an HIV positive health care worker that works in the lab. ER was a zoo, so to help out, I went over to draw some blood off a patient. I made a silly, amateur mistake. I was using a syringe and was dividing the blood into the tubes. At the last tube, I glanced at the patient to make sure he was okay and still applying pressure, I ended up missing the tube entirely and jammed the needle into my hand instead. He was a hard stick, so I quickly changed the needle and finished putting the blood in and then washed the site.

I didn't exactly report the incident as I should have. I live in a small town where the stigma against HIV is high and many people, including coworkers-(even the nurses and a few doctors) still aren't educated that well about HIV. Part of the protocol would be to test both me and the patient for HIV. Even though you technically can refuse to sign the consent, the right to refuse is merely theoretical. I just didn't feel I could deal with another job where I was ostracized for my status, so I decided I would make an appointment privately with my doctor to get tested for hepatitis.

I have a few questions.

1. If the guy was HIV positive and had a drug resistant strain, do I have any need to worry about that given that I am on medication? I know that HIV risk from a needlestick is low, but does an already HIV positive person have to worry about another person's strain?

2. How long after exposure do I need to use to test for HCV? The status of the guy was unknown, but the area I live in the two big drugs of choice among many of the town's population is meth and heroin, so I figured better to be safe than sorry since they don't always care about safe practices such as using clean needles.

3. I just got a booster shot because recently my tests showed that my HbSAb titre was nonexistant after my hep B series. Should I get tested for Hep B as well?

Thank you for your time. I also must say that you have the patience of a saint, because these worried wells who have no idea how lucky they are to merely be chasing a disease they don't have versus actually having the disease would have annoyed me to no end--probably good I am heading toward my PhD and will be in a lab instead of getting the MD and seeing patients.

Response from Dr. Frascino

Hello,

1. Whether or not you even have a theoretical risk would depend on if the source patient's virus was resistant to the antiretrovirals you are currently taking. Overall your risk of superinfection would be extremely low. The only intervention to take at this time checking a resistance test -- would be necessary only if your viral load suddenly started to rise.

2. PCR should detect HCV within two weeks.

3. If your HBV-antibody levels are nonexistent, you should be revaccinated with the full series of three injections. I a single booster may not be enough to provide adequate immunity.

I still find it disheartening that 25 years into the epidemic (1) your coworkers, doctors and nurses in an emergency room "still aren't educated that well about HIV" and (2) you have to potentially compromise your health because you fear being ostracized if your HIV-positive serostatus became known.

It obvious that, 25 years into the pandemic, we still have such a long way to go.

Good luck.

Dr. Bob



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