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MD exposed
May 26, 2006

I am a physician exposed 9 weeks ago. Puncture wound with scalpel to right hand. Patient status : AIDS. Underwent 4 weeks of triple prophylaxis , 28 days. 1 week after stopping I felt symptomatic. Got checked and an Elisa, western blot and PCR were drawn, that is 35 days after exposure, 7 days after stopping the meds, all caqme back negative . Since then I have been negative at 6 weeks and 9 weeks ELISA only. My specific question is regarding PCR. How good is the PCR alone in detecting early viremia 35 days after the initial exposure and should I be confident based on that result that infection did not take place. Thank you for the great job yo all do on this web site supporting the commuity.

Response from Dr. Frascino

Hello,

I do not recommend PCR testing for routine HIV screening. Certainly your negative ELISAs out to nine weeks are very encouraging. I suggest you follow the updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV. You can download the guidelines form the U.S. Public Health Services Web site or from the CDC's MMWR (June 29, 2001/50 (RR 11); 1-42).

I cannot address your specific question about PCR, as I don't know whether you had a DNA PCR or RNA PCR. Assuming it was an RNA, false-positive tests occur in 2% to 9%, usually at low titers (less than 10,000 copies/mL). Sensitivity depends on viral load, threshold of the assay and status of antiretroviral therapy. Sensitivity can approach 100% with acute HIV infection; specificity is 97%, but increases to nearly 100% with viral loads greater than 10,000 copies/mL.

Hope that helps.

Good luck.

Dr. Bob



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