Question

Hi there. Iv been reading pretty good answers here so that i could clear my confusion too.

I was removing an IV line from a seroreactive patient in the wards on Saturday, and in the process as the line was coming out the fluid running thru the line but from the patient, splashed on my face. I didnt feel it enter my eye. But on consult with a doc, regarding the uncertainty with a splash was advised to start pep.

So i have been on pep since Monday. I really dont think i need the pep though because there was no blood splash per se.

Then on tuesday, still on pep, while doing an MVA i felt a drop of blood on my lower lip which i cleaned off at the end of the procedure. Im not sure whether i ended up swallowing the drop - i probably did. The patients status is unknown.

After 5 days on PEP, I have developed a tinge of jaundice. And did my LFTs with my total bilirubin raised at 116 umol/L and conjugated at 11. My liver enzymes are within normal,just my ALTs at bordeline high (42).

My initial regimen was AZT/3TC/LPVr - now changed to TDF/3TC/ATVr due to high intolerability. But its still intolerable with about 10 vomits per days and constant nauseated feeling.

Sorry for the long message. BUT DO I REALLY NEED TO CONTINUE WITH PEP? I will really appreciate your input.

Answer

Hello and thanks for posting.

Your exposure seems very low risk, if any.

Regarding the first exposure, since the fluid was from the IV line and contacted intact skin (not mucous membranes), there's essentially no risk.

The second exposure similarly was of low risk- being on your lip, and oral exposure risks are very, very low.

Last, you've developed a characteristic side effect of both LPV/r (presumably gastrointesetinal) and ATV/r (jaundice). I would not consider vomiting 10 times daily and constant nausea acceptable side effects. (BTW, this is why modern PEP regimens recommend the far better tolerated integrase inhibitors over boosted protease inhibitors.)

Overall, I'd be supportive of stopping your PEP regimen. I probably would not have recommended it with your described exposures, and you've developed significant intolerance to the medications.

Hope that helps, BY