Simple Question, Need Your Advice

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Dear Dr.

Let me start by thanking you for all the help and support that you are providing to people that desperately need them. Also, I do apologize in advanced for my question if it seems too trivial but it is obviously bothering me and I need your advice. Based on your previous responses to me and other members of this board, I recognize that other than unsafe sex and shared injection drug use, there are very limited number of routes that HIV can be transmitted. My question is regarding blood exposures. About 25 days ago I cut my hand on a very busy door knob in my apartment building. There was a sharp pin at the door knob which I believe it belonged to the spring inside the handle. I mostly believe that this incident was not a cause for concern, however given the fact that this door knob is constantly used, I’m worried that there might have been somebody else within 30seconds of me cutting my hand that also cut his/her hand and therefore left some blood on the pin (the pin looked clean but I can’t be sure). Also, since there was more that 10 years from my last tetanus shot, I went to my doctor and got the Tdap booster vaccine. The only other things that are bothering me now are two small swollen glands in my collarbone area (same side, near the injection site of the vaccine). I appreciate if you can please provide answer to my following questions:

1- Is this incident a cause for concern for HIV? Is testing necessary?
2- Is 30 seconds enough for any possible blood (1or2 drops) on the sharp pin to be not infectious (due to air exposure)?
3- Are the swollen glands (with no other symptoms) worrisome for HIV infection or are they possibly due to vaccination and/or shaving irritation on my neck?
4- Finally, as a scientific question, do you think that vaccination during ARS can make the symptoms more severe (because of already weakened immune system due to HIV infection)?

Thanks. I simply like to move on and need your help. I will not bother you with more questions.

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Thanks again Doctor for your help.

[H. Hunter Handsfield, M.D.]

There are no medicines or vaccines that alter HIV test reliability, except maybe potent chemotherapy (even that is theoretical, with no actual cases known).  Certainly your Tdap vaccination will have no effect.

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Hello Dr.,

Over the past few weeks, and based on your comments, I managed to reduce my anxiety significantly. Today, I decided to get tested at 8 week mark just to completely let go of these irrational fears. The results should be available next week. Now my only question is that should I be worried about a possible false positive result due to my tetanus booster shot (Tdap) 6 week ago? The nurse at the clinic mentioned that it's possible but not likely. Do you agree?

Thank you in advance.

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Dear Dr. Handsfield,

Thanks for your detailed answer to my question. I know that this level of anxiety over non-exposure events is not rational and that is why I am seeing a therapist to help me overcome this fear. Your reply was extremely beneficial for me since it helped me accept the fact that this was a no-risk situation and I need to focus on moving on. Once again thank you for your help.

[H. Hunter Handsfield, M.D.]

Welcome back.  I remain concerned that you continue to have difficulty understanding HIV transmission and continue to fear non-exposure events that are not worth any worry or ven a second thought.  But I'll try to help once again.

Environmental exposure to blood, or getting injured in the presence of blood or body secretions that may be contaminated with HIV, is one of those theoretical risk factors that some people worry about, and that some health agencies list as possible routes of transmission.  But the fact is that no such actual HIV transmissions have ever been reported, to my knowledge.  And if you think objectively about this particular event, it is logically not only implausible but outlandish to worry that an HIV infected person had also been injured on the same pin, that the pin retained any blood from the event, and that it occurred so recently that HIV could survive in sufficient numbers to cause transmission.  The odds of that sequence cannot be higher than one in many billion -- truly zero, in other words.

To your speciifc questions:

1) No cause for concern, definitely no need for testing.

2) I don't know about 30 seconds per se.  The odds of the entire sequence of events are what matter.

3) HIV doesn't cause localized lymph node inflammation.  I don't know the cause of this problem -- whether inflamed nodes or something else, and if nodes, what might be responsible -- but it isn't HIV from the pinprick.

4) I am unaware of any evidence that routine immunizations have any effect on ARS symptoms.

Bottom line:  No risk, no basis for concern, no need for testing.

Regards--  HHH, MD