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Suture needle stick

Aug 2, 2011

Hello Dr. Frascino! About 3 weeks ago while suturing an HIV+ patient`s profusely bleeding neck wound I sustained a needle stick injury. It was a solid, cutting suture needle that caught my left index PIP joint breaking the skin and eliciting blood - not deep but enough to feel it. This was a 5th or 6th stitch with this needle, cannot remember if there was visible blood on it. I was wearing sterile gloves and noticed the blood underneath. I proceeded to wash the wound with soap and water and bled the wound for over 15 minutes. Within 1.5 hours I started PEP (Lamivudine/Zidovudine 150mg/300mg and Lopinavir/Ritonavir 200mg/50mg). I have been tolerating the medication better then most with some transient elevation of Bilirubin and LFTs that are currently back to normal. The patient`s last viral load done in March 2011 was undetectable. My main question is, has there been a known case of seroconversion from a suture needle injury? Should I get PCR, ELISA or both done at 6 weeks post exposure? I have done all sorts of research on the topic and am well aware of the probabilities, but unfortunately the fear is gripping. Your thoughts on the matter would be most appreciated! Resident

Response from Dr. Frascino

Hello, Resident.

Your HIV-acquisition risk from this occupational exposure is very low, but not completely nonexistent. A course of PEP is warranted.

Factors decreasing your HIV-acquisition risk include:

1. Solid, rather than hollow-bore, needle

2. Needle had to travel through latex glove before reaching you.

3. The wound was not deep.

4. The patient's last viral load was undetectable; consequently, he was probably on antiretroviral therapy at the time of the incident.

5. You started PEP within 1.5 hours.

Responding to your specific question, yes, there have been documented cases of HIV transmission from suture needle injuries reported in the medical literature. However, please remember there are many variables involved in HIV transmission, involving both the virus (viral strain, viral load, etc.) and the host (host immune integrity, concurrent illnesses, whether PEP was taken and when it was started, etc.). No two occupational exposures are the same. You did everything you could. Your next step would be post-PEP HIV testing. PCR testing is not recommended. Rather, HIV-antibody testing (ELISA) should be done at four-to-six weeks, three months and six months from the date of exposure.

Good luck. I'm here in case you need me, OK?

Dr. Bob

Masturbation with prostitute's saliva, shaved pimples on face, feel feverish 2 wks later

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