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risk of seroconversion in an occupational injury
Jun 13, 2011

Hi Doc RJ Franscino

Im a 5th year medical student who has had a needle stick injury, 3 days ago from a 4 day old infant of a Retroviral disease positive mother. The child is on nevarapine and the mother took PMTCT 4 weeks before labour.

my concern is that after i was pricked i was so shocked that i didnt follow all the correct procedures, i wiped the pricked area with cotton wool and stopped the bleeding and only reported the matter 6 hours later. it was a paediatric needle and it was not bloody. currently i am on the pep, and i am worried that i might have reported the matter too late. How fast does the virus replicate and taking my story into consideration, what are my chances of seroconverting in this regard? i am trying to keep a positive attitude and i know the risk of becoming infected from a needle stick injury is only about 0.3%, but i cant help but wonder.

thank you in advance

Response from Dr. Frascino

Hello, Medical Student.

Your HIV-acquisition risk is very low, much lower than the 0.3% statistic you cite. This is because the infant was on antiretroviral therapy and the prick didn't sound severe (there's an increased risk with a deep puncture and/or with a large hollow-bore needle). It's also worth noting that if the mom took nevirapine to decrease the risk of mother-to-child transmission (MTCT), there's an excellent chance the baby is HIV negative.

Post-exposure prophylaxis (PEP) effectiveness decreases as the time form exposure increases. Once 72 hours has lapsed, PEP is no longer felt to be of any benefit and would not be recommended. Your six-hour interval is reasonably brief and PEP should significantly further decrease your already low HIV-acquisition risk. Try not to worry too much. The statistical odds are astronomically on your side that you did not acquire the virus from this occupational exposure. Continue your PEP treatment and post-PEP follow-up testing.

Good luck. I'm here if you need me, but I strongly doubt you will, OK?

Dr. Bob



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