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Panic about HIV disclosure
Feb 28, 2012

Dear Mr David Wohl, I have an inquiry regarding the HIV transmission and the use of post-exposure prophylaxis for the case as follows: Yesterday, when I was riding a motorbike on street, there was an impolite guy who suddenly spit on the street. Unfortunately, I rode my motor just right behind that guy's motor bike, and I recognized that my face, typically my lips and cheek were contaminated by his spit. My concern, is, in case of the blood availability mixed with his spit, I may have some risk of infection. I have read numerous documents about HIV/AIDS transmission, and I quite understand it. My case, however, is somehow rare so I am quite uncertain of it, which is also the reason I prepare this inquiry under the hope looking for your advice. I noted that my lips and cheek were intact at the time of the accident, except for some pimples on my face. I don't know whether it is a way for HIV transmission. After the case, I immediately went to a local hospital specialized in tropical diseases in Vietnam. I told the doctor there about the case, and he advised to have a HIV test before using PEP, zidovudine (AZT) and lamivudine in 01 month. He prescribed me the PEP for 05 days without telling me how to use it while I am waiting for the basement test. When I asked him whether my risk is high, he told me not. Another issue is on October 2011, I did use PEP for 28 days which was prescribed by the same hospital, with the same formula of zidovudine (AZT) and lamivudine for a low-risk exposure (I tested my urine at a medical center before studying abroad. During the course preparing to pee in a small plastic container, I dropped its cover in the waste container in the center's toilet, I got scared for contaminated with blood and asked for PEP). Until now, I haven't performed any testing since the completion of PEP in October 2011. My questions are: 1/ Will it be conclusive if I perform a Combo HIV test tomorrow, 27th Feb 2012, approximately 04 months after finishing PEP as aforementioned? The reason I want to do the basement test tomorrow is I do not want to pass the 72 hour regulation for PEP usage for this recent accident. 2/ Is it necessary to use PEP in my first mentioned accident (spitting man)? 3/ Can PEP fail? For what reasons? 4/ If a person uses PEP twice in a period of 01 year, will there be any potential risky effects for him afterwards? I did read some materials prepared by CDC, and I was informed that there are also some people asking for PEP twice in 01 year... I am looking forward to your kind response. I am very nervous now...

Response from Dr. Wohl

There is no way I can imagine that this spit could infect you with HIV. I would not recommend PEP and I would advise an HIV test only to reassure you you are not positive. Feel free to test now and in a month and then forget this incident. Consider a helmet with visor, if possible. DW



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