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Jul 2, 2007

Dear Dr., Quick question: A HCW had a needlestick injury involving a pt of known HIV/HepC status and was then treated with Combivir/Tenofovir for 4 weeks for this exposure. She has had an 8wk ELISA (neg) (4wks after completion of PEP), and a 9wk RNA-PCR (not-detected) (5wks post completion of PEP)for some non-specific symptoms. She is still very anxious about this and having a hard time foucusing on her work. Can you tell me about the reliabilty of these test ? Are they conclusive ? What should be the plan for further testing if any given that the pt was on PEP for the 1st 4wks ? Thanks in advance for writing back. -RT

Response from Dr. Frascino

Hello RT,

This is one of the reasons I feel strongly that anyone who has sustained an HIV exposure significant enough to warrant a course of PEP should be followed by an HIV specialist. HIV specialists are best trained to evaluate and document a potential exposure, suggest and optimize a PEP regimen when needed, evaluate and manage all PEP-related side effects and toxicities and arrange for and evaluate post-PEP follow tests.

I would suggest this patient follow the Department of Health and Human Services/Centers for Disease Control and Prevention guidelines as published in the "Updated U.S. Public Health Service Guidelines for Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis." These can be easily downloaded from the CDC or the MMWR (Sept 30, 2005/vol 54/No RR-9). The guidelines recommend HIV-antibody testing at baseline (time of exposure), 6 weeks, 12 weeks and 6 months. Extended HIV follow-up (e.g. for twelve months) is recommended for Health care workers who become infected with HCV after exposure to a source patient coinfected with HIV and HCV. Dr. Bob

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