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Fellow doctor needs help
Mar 14, 2009

HI Dr Bob, Thanks for your promt reply. Sorry i did not tell u the whole story! I did take PEP and am getting tested by occupational Health. As u can probably imagine the reason why i got the HIV NAAT test at 4 weeks because the literature suggest that it can detect HIV infection the fastest! I know its not recommended, but wanted your opinion if it fastest way to detect HIV infection, and how reliable it is?? I did that test by paying out of pocket to get answer faster so i can function normally again!!

Response from Dr. Frascino

Hi,

Thanks for the additional information. You are correct: Nucleic acid amplification tests (NAAT) can detect HIV infection earlier than HIV-antibody assays; however, you are also correct that this type of testing is not recommended for routine HIV screening, because of the rate of false-positive test results, other technical considerations and cost. Large population studies have also not been completed that would allow us to ascertain sensitivity and specificity for NAAT at four weeks, particularly because you took PEP presumably for 28 days. My advice is to follow the published guidelines for post-PEP testing and also follow the advice of an HIV specialist (one should be following your occupational exposure, course of PEP and post-PEP testing).

Good luck.

Dr. Bob

fellow doctor needs help Mar 10, 2009

hey Dr Bob, I am a third year cardiology fellow. 4 weeks back I had a needle stick injury. Unfortunately, the patient was HIV positive. since that day i am not able to function appropriately!! I did some literature search and got a NAT HIV test and Standard antibody testing at the 4 weeks post exposure. Both tests turned to be OK. do you think i am safe now?? please reply if u can

Response from Dr. Frascino

Hi,

I'm amazed you've made it through medical school, internship, residency and three years of cardiology and still have so little knowledge concerning occupational exposures to bloodborne pathogens! This is a deficiency in your training!

Are you safe after a four-week NAT and HIV-antibody test? No. I suggest you download and read a copy of the "Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post-exposure Prophylaxis." (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm)

Did you report your exposure to occupational health? Did you get evaluated by an HIV specialist to ascertain if PEP was warranted? Regarding HIV testing following an occupational exposure to HIV, the guidelines recommend HIV-antibody testing at baseline, 6 weeks, 12 weeks and 6 months from the exposure date. Certainly your negative tests at four weeks are encouraging, but not yet definitive.

Good luck and remember to study up on occupational exposures to bloodborne diseases. It just may save your life someday. Also make sure you share the information with your team of fellows, residents, interns, medical students and perhaps even your attendings!

Dr. Bob



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