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Occupational exposure and testing (DNA PCR)
Dr.,
I am a dentist who had an occupational exposure on an HIV positive patient. I got an abrasion on my elbow from a dental bur that I had used on this patient. My elbow did not bleed, but the skin was pinkish where the abrasion happend. The bur I cut my elbow on was covered in blood earlier in the procedure, but I believe it had been rinsed off pretty well by the time this incident took place, and it may have even been dry. At this point I wish I had assessed the situation better when it happened. I immediately rubbed the area with copius amount of Purell hand sanitizer.
The ER and Employee health at the hospital I work placed me on PEP consisting of Kaletra and Truvada for 30 days. Apparently the patient had detectable viral loads and some drug resistance. I was told that my actual exposure was low risk maybe 1/1000 to 1/3000 chance of acquiring HIV, and that the PEP would cut that by ten-fold.
I am not overly worried about actually contracting HIV since my risk seems fairly low. My main concern is the duration of the testing I have to undergo and its effect on my life. I have been told by employee health to test at 6 weeks, 3 months, and 6 months. I will take my 6 week test in about 3 weeks from now. I just do not like the long follow up time with the other tests. I am a young guy looking to date and I am worried about scaring off potential partners by telling them I am not cleared from having a possible HIV infection.
I have heard about the DNA PCR test and am thinking about taking it. I have heard that it is not used because of a high false positive rate and a high cost. I was quoted that the test would cost me $300, at a facility outside of my hospital, which I am more than willing to pay. I also want to to take the test after my 6 week antibody test that way I would be less worried about a false positive result. I want to take the DNA PCR test as a means of final clearance to avoid the 6 months of testing.
Thoughts?
MEDICAL PROFESSIONAL
The first paragraph of your follow-up message simply states your correct understanding of my original reply. The reason for your desire for a resolution earlier than 6 months was also clear in your original question. And I'm sure you understand I can't do anything about the knowledge level of the employee health folks or the clinic arrangements at your hosptial. But most likely the ID doc would understand your concerns and might agree to meet you someplace other than the usual clinic. If not, you might be able to find a different ID specialist at another institution.
Sorry I can't be more helpful, but there's only so much a distant online source can do.
Sorry I can't be more helpful, but there's only so much a distant online source can do.
Thanks for the answer Dr.,
Just a quick follow up. It seems that on other posts you assure patients who have taken a DNA PCR at 6 weeks or later and have tested negative. that they are HIV negative. In my case you believe the PEP could delay these results? My main concern is the 6 month testing period because I would like to start dating and do not want to scare off potential partners by telling them I am still undergoing HIV testing.
Also, I am not real happy with the employee health department, which is now handling my case. They do not seem real knowledgeable on the subject and it is frustrating to me. They seem to have a manual they follow and are perplexed by my questions. I am going to try to contact an infectious disease doctor at my hospital in the next few days. I am hesitant to meet with them in person though because alot of patients I see in the dental clinic are referred to me from the std clinic in the hospital and I don't want to run into them in that setting.
Just a quick follow up. It seems that on other posts you assure patients who have taken a DNA PCR at 6 weeks or later and have tested negative. that they are HIV negative. In my case you believe the PEP could delay these results? My main concern is the 6 month testing period because I would like to start dating and do not want to scare off potential partners by telling them I am still undergoing HIV testing.
Also, I am not real happy with the employee health department, which is now handling my case. They do not seem real knowledgeable on the subject and it is frustrating to me. They seem to have a manual they follow and are perplexed by my questions. I am going to try to contact an infectious disease doctor at my hospital in the next few days. I am hesitant to meet with them in person though because alot of patients I see in the dental clinic are referred to me from the std clinic in the hospital and I don't want to run into them in that setting.
MEDICAL PROFESSIONAL
I would like to help, but this forum really isn't the best place for the advice you need. If the ER doc and/or employee health physician you have seen are HIV/AIDS experts, I suggest you follow their advice. Alternatively, seek out such a physician, probably an infectious disease specialist in your community. It would be wiser to follow such a person's advice than that of this forum or any distant expert.
My general sense is to agree with your own analysis that the risk you were infected is very low. In general, it almost never takes as long as 3 months, let alone 6 months, for HIV seroconversion (i.e,, to development of a positive HIV antibody test). However, to my knowledge there are no data on whether PEP might prolong the seroconversion interval -- that is, if PEP fails to work, whether it might take longer for an antibody test to become positive. There also are no data, to my knowledge, on performance of PCR tests during the seroconversion window in the face of PEP.
Certainly I can understand your desire to have a final answer as to whether you acquired HIV without waiting 6 months. My best judgment is that a negative PCR test at 6 weeks, plus a negative antibody test at about that time -- or perhaps out to 3 months -- would be reliable evidence you were not infected. But I don't know that and cannot give you definitive assurance about it. That's a logical probability but no more than that.
Sorry I can't be more helpful. Best wishes-- HHH, MD
My general sense is to agree with your own analysis that the risk you were infected is very low. In general, it almost never takes as long as 3 months, let alone 6 months, for HIV seroconversion (i.e,, to development of a positive HIV antibody test). However, to my knowledge there are no data on whether PEP might prolong the seroconversion interval -- that is, if PEP fails to work, whether it might take longer for an antibody test to become positive. There also are no data, to my knowledge, on performance of PCR tests during the seroconversion window in the face of PEP.
Certainly I can understand your desire to have a final answer as to whether you acquired HIV without waiting 6 months. My best judgment is that a negative PCR test at 6 weeks, plus a negative antibody test at about that time -- or perhaps out to 3 months -- would be reliable evidence you were not infected. But I don't know that and cannot give you definitive assurance about it. That's a logical probability but no more than that.
Sorry I can't be more helpful. Best wishes-- HHH, MD
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