Sep 7, 2011
Hello Dr. Bob,
I was performing a biopsy on a HIV + patient with a half razor blade. I don't know if you are familiar with that tool, but it is a flexible instrument that is held with my thumb and index finger. The top edge(clean end of the blade) cut my thumb during the biopsy. I looked at glove and there was no blood on it, but there was a hole in my glove and laceration to my thumb. There was blood on the patients skin and bottom edge of the razor blade. I quickly finished the biopsy. I put the specimen in the bottle. I think I was in such shock that I had cut myself so don't remember what happened after that. I forgot to check my cut glove to see if the patients blood had touched my broken glove/skin. All I know is when I took my glove off I was bleeding. This patient was on anti-retrovirals(atripla). Said his viral load was undetectable. I started PEP within 4-5 hours as a precaution because I don't want to take any chances. Is my risk of getting HIV high? This has consumed my everyday. I know all I can do it wait to test, but I can't help obsessing about it. Also, I checked my glove in the trash can later and there was blood on the thumb portion of the glove. I don't know if it's mine or his or both. If I cut myself with the clean edge of the blade and then came into surface contact with his blood(not through a direct needle stick) but still through an open wound what are my chances? Probably and impossible question for you to try to answer. But any guidance will help. The information I can't find is...have people come in contact with an hiv + patients blood to their open bleeding wound and not become infected? It seems unlikely. Is the 1/300 chance of a healthcare worker becoming infected a statistic of people who have actually had an HIV + patients blood enter their non-intact skin? Or is that a stat from superficial wounds, intact skin? Thanks for your time and reply.
Response from Dr. Frascino
The statistics you found are correct. There is a 1-in-300 chance of contracting HIV following a significant occupational exposure to a patient confirmed to be HIV infected.
Your overall HIV-acquisition risk remains quite low based on the information you provided. I would advise you finish your course of PEP and then follow the post-PEP HIV-testing guidelines which recommend follow-up HIV tests at four-to-six weeks, three months and six months from the date of exposure.
You can read additional information about occupational exposures to HIV and their management in the link below.
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