dentist ultrasonic scaler

Question

Hi Doctor, Im a dentist, i have today treated a HIV positive patient who is generally symptom free. I used a cavitron water irrigating ultrasonic scaler in his mouth but not directly had contamination with blood. One wrong movement and the tip of the scaler touched my underarm. I felt a sharp sensation but could not press out any blood despite hard pressing. I went to local hospital and i was given PEP prophylaxis after ca 2hs. I am really worried. How do i know if the skin was penetrated? Is the cavitron scaler tip that is constantly irrigated with water same risk as a needle? can I be tested For HIV while I am on the prophylaxis? I really appreciate your urgent reply. Many thanks.

Answer

I do not see the basis for PEP given there was no penetration of your skin with anything that would be contaminated with HIV. The tip of the instrument touching your arm is different than a sharp penetrating your skin. Plus, is the cavitron tip really in much contact with the patient?

Given what you write, I think this is overly cautious.

However, now that you went down this road, you should get tested now (baseline) and again at 12 weeks if using an HIV antibody test. A Duo (antibody/antigen) test can be performed earlier (see: http://www.cdc.gov/hiv/pdf/HIVtestingAlgorithmRecommendation-Final.pdf).

If PEP fails, the person will have replicating virus and this will be detectable by RNA and p24 testing. Standard HIV testing protocols apply even in those on PEP.

DW