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Follow up Question for DR Wohl hiv transmission via needlestick.
Jan 18, 2012

Hi Dr Wohl, thank you for your response. Im sorry to waste your time, but have a few follow up questions as to why you think my tests are reassuring. I also wanted to mention to you that I finished pep on 01/04/2012. I had another hiv oraquick test done at 5 weeks (yesterday) post needlestick injury simply because i couldnt take the anxiety anymore. It was negative. My questions are: 1. My ID dr says that if i have a negative hiv test at the six week mark then it is safe to resume unprotected sex with my husband. Im not sure i feel safe about this. I keep reading everywhere (including CDC) that says if a person completes PEP, the pep can delay seroconversion and thus said person should be tested out to six months to 1 year. Im terried and really do not think I can wait one year to know whether or not I have hiv. I am not willing to put my husband at risk. 2. I understand that my pcr test returned zero copies dected, but isnt that the goal of antiretrovial meds to begin with? So if i was already on the pep for 16 days would my viral load be zero? or would it take some time for it to reach zero? Does an HIv pos person ever reach zero? or would zero mean a cure? im confused as to the differece between zero and undectable. Does undectable mean that they found hiv, but can not count the copies? 3. I have graves disease, i was hyperthyroid, had RAI in 2010, and now have hypothyroidism and take synthroid and cytomel. does this autoimmune disease effect my ability to seroconvert, or have a delay? 4. i have read and been told so many confliting information that im confused as to when i should feel comfortable and end the worry. ID dr says after six weeks, my family dr says six months, other Drs have said three months past the last dose of pep, and CDC says up to one year after pep. please please please tell me that I don't need to spend all of 2012 with fear, anxiety, and depression. I feel bad for my husband because i refuse to even have sex with him with condoms out of fear of breaking or any scinero that could arise. please help shine some light. thank you in advance for your time and help.

Response from Dr. Wohl

Listen to your infectious diseases doctor. She/he is correct. There is no need for extended HIV testing. Guidelines regarding occupational exposure are old and are being revised right now.

HIV medications taken as PEP are intended to prevent infection. If they do not do that you get infected and get a detectable viral load and ultimately antibody production. Your viral load testing reveals no virus.

The viral load test looks for actual virus. It is very sensitive but commercially available tests can not detect HIV in extremely low concentrations. Most of these assays have a lower limit below which they can not find the needle in the haystack. Typically this is 40 copies of HIV in a milliliter of blood plasma. Under this level we call the result undetectable. In your case undetectable equals none.

If you really are worried, and you are, get another viral load test off PEP. If you are infected it will be detectable. I think this is unnecessary but I am not sure you will otherwise be convinced. DW



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