Drs please help me. HIV positive needle stick injury

[Mommy2one2007]

tuesday while at work (phlebotomist) I was drawing an HIV positive patient's blood using a butterfly needle Size 23 X 3/4 gauge needle. After I completed drawing approx. 9 tubes of blood  went to remove the needle from a vein in his left arm I don't know how it happened but I think I pulled it out to quickly, that my fingers slipped down the tubing of the needle causing the needle to fly out of his arm and swing around a bit. ( i still had a hold of it by the tubing). It happened so fast that I basically was stunned with fear. So i honenstly don't recall any painful sticks. After he left i went straight to the bathroom. I removed the glove from my left hand and filled it up with water, sqeezed it to see if it had any holes. None. I did the same with the glove on my right hand and noticed a pin size hole in the glove between the thumb and index finger. I panicked and washed my hands right away with soap and the hottest water i could stand. I honestly don't know if i had blood on my hand anywhere because i washed them as soon as i seen the hole in the glove. I reported this to my employee health right away. They sent me to and infectious control dr who just so happens to be the DR of the patient i was drawing. She put me on truvada and kaletra. Truvada once daily and kaletra 4 times a day. She also told me that his t cells have been 700, and that his viral load has been low since 2001. I keep telling myself that if it was a deep stick i would have had to feel it, and that it would still be sore even after. and still would have bleed even after washing hands. Maybe even the next day. Wishful thinking maybe. Everything i read says the rate of transmission is about 0.3 percent. But does that stand for people on PEP also, or since I started pep within 2 hours of this happening does that give me a lower than 0.3 percent chance of infection? please give me some adivce and some satistics. I am truely terrified. I have not been sleeping/eating. please help me.

[Edward W Hook, MD]

I'm please to hear your followup and, as I said before, this thread had to end.  I agree with your doctors that this is strong evidence that you did not get HIV from the exposure you described.  

There will be no further answerrs.  Take care EWH .

[Mommy2one2007]

Dr hook, I.wanted to follow up with you and let you know that my recent hiv antibody test was negative. The id dr said that people who develop hiv would test positive between 4_6 weeks and that I should feel comfortable resuming unprotected sex with my husband. Im not sure if im comfortable with this.
1. How reliable is this negative, and what does this likely mean for my 12 week test.
2. I keep reading that after pep a person can take a year to test positive. Is that true? Do I really need to spend my.new year terrified ?
3. I did have a pcr test that showed zero copies. Can a person who has hiv ever reach zero. It is my understanding.that undectable and zero are not the same. Would a lab report read something like hiv dected at less than _ copies?

[Mommy2one2007]

Hi dr hook, hope you had a wonderful christmas. I wanted to thank you for all of your comments and help. I agree that the people at employee health should be answering all quuestions and most of all the id dr. im sorry that didnt happen the way I would have liked. I wanted to.follow up and let.you know that my antibody test was negative, and my pcr hiv was ZERO copies detected. Thank god. This has been a nightmare for me because I have never exposed myself.and have always practiced safe sex, and felt.like my world.came.down from me trying to do my job. So thanks again dr, you have been so much.help to me. I will update you on my six week test that I take in three weeks. Happy new year to.you and yours.

[Edward W Hook, MD]

As I said, your doctors need to be doing their job- that means not only writing you prescriptions but explaining what they are doing to you. Thus I will answer this last question but then you need to get this sort of information from them.

While your risk is very low,PEP is not 100% efective. If it fails, the virus will be detectable and detectable before the antibody test becomes positive. Thus the PCR test is the correct test to perfrom to make sure that you have not gotten HIV.  I would have ordered the same test.  As I said, your exposure was low risk, the patient had a very low viral load and it is unlikely the PEP will fail.  Your doctor has ordered the correct test.  If the PCR test is negative, your recent symptoms are not due to HIV.

Don't worry about the DUO tests, they are not the correct test for your situation and and not widely available.  

This will end this thread.  You really need to be seeking these answers from the doctors who are treating you. EWH

[Mommy2one2007]

Ok, this makes sense except for.one thing.. Why order a viral load if im taking pep? Wouldnt the pep make the viral load undectable if there in fact is a virus? I will find out tomorrow the result of the 16 day antibody test. I realize this doesnt change much as its quite early to do an antibody test, but im still hoping for a negative. If the pcr is negative what will that mean in terms of my likelyhood to develp hiv. I hear about duo tests, it that what ive had? Thank you doctor.

[Edward W Hook, MD]

I'm so sorry to hear that the ID specialist did not explain the testing performed.  It is most likely that you just have one of the winter colds that people get from time to time but the tests were to make sure that your symptoms were not due to HIV. The fact that you improved over night is further indication that  your symptoms were not HIV.  The PCR test however is the important test.  

This is unlikely to be IV., When you get the PCR test, a negative test will confirm what I've just said.

Finally, the people at employee health are the ones who should be explaining their tests to you.  Please insist that they do their job. EWH

[Mommy2one2007]

Dr hook, today I am feeling better, have not vomited or felt nasous, temp is back to 98.0 F. My emplyee health contacted me today stating that the cmp was normal, but my cbc was normal except my neutrophil was high at 91.3 with a cut off of 83.1 and my lymphocytes were way low at 5.3% normal cut.off at 33%. Does this happen during hiv infection? No one is really explaining anything to me, the ID dr is on vaction and from what im reading all I can find is lymphocytes decrease with hiv. Does this happen in the begining stage, or later? does this happen with a cold? Im terrified, depressed and have pretty much convinced myself.that I have contracted hiv. If you.were in.my sitiation.would.you.be concerned? Please give me some.hope. Thank you

[Mommy2one2007]

Dr hook, today I woke up feeling very nauseated, and have vomited twice today, feeling a lot of fatigue and muscle weekness. Highest fever has been oral at 99.9 F. I called the infectious disease dr who ordered a cmp, cbc, hiv antibody and a quantitative hiv by pcr. She didnt explaim this test. What is it? Will it even be accurate at 16 days post exposure? Wouldnt it be suprresed with the pep? Do my symptoms sound like seroconversion? Thank you.

[Edward W Hook, MD]

The lower the viral load, the less likely transmission is to occur.  A viral load of 139 is quite low, in fact it is lower than what we were able to measure even just a few years ago and is in your favor.  A negative six week test will (I say will because that is the result I anticipate you will receive) be good preliminary evidence that you will not develop HIV.  Take care. EWH

[Mommy2one2007]

Dr hook, I learned today that the viral load of the source patient was one hundred thirty nine.  Does this change your opinion of my chances? Im having blood work tomorrow, a cmp and cbc to monitor kidney function with.the pep cocktail, but still have four weeks to my first hiv test. Waiting is killing me. If my six week is negative, and I pray that it is, is this a good standing point for my next scheduled testing.. 8weeks, 3 months, 6 months etc? Thank you dr hook.

[Edward W Hook, MD]

I nee to caution you about now trying to split hairs. The 0.3% figure is an average figure generated from many reports of sticks which were most often deep enought to draw blood with needles of a variety of different gauges.  

A deep stick would be obvious.

Althought your risk of infection in tiny, the recommendation and the safest course is to use condoms for sex with your husband.

Please lets not go to the "has it ever..." of "what if..." questions. They are neither useful or productive.  EWH

[Mommy2one2007]

Dr, if I may ask one more question, . I am curious as to the 0.3 percent sastistic. Does this include those who have had deep sticks with larger hollow bore needles, scaples etc? For the sake of arguement, if this was a deep stick, is my chance still slim to none? Even slight pokes can draw blood, but would a deep stick be obvious? Also because I was using a 23 gauge butterfly needle, would there even be a lot of his blood on/ in.the needle? Should I continue sex with my.husband? Thank you a million times.over.

[Mommy2one2007]

Thank you dr. your advice has been helpful. I am curious as to the 0.3 percent sastistic. Does this include those who have had deep sticks with larger hollow bore needles, scaples etc? For the sake of arguement, if this was a deep stick, is my chance still slim to none? Even slight pokes can draw blood, but would a deep stick be obvious? Thank you doctor.

[Edward W Hook, MD]

Yes, your calculations are correct. Actually, my guess is that your risk is actually lower than even the calculated figures.  Take care. EWH

[Mommy2one2007]

Dr. thank you a million times for your quick reply. The rational part of my brain tells me I have a better chance of getting killed driving down the road in my car than of getting hiv from this. The other part of me says well maybe you did draw blood and didnt.notice due to washing my.hands right away.  I realize that even a small surface poke can cause bleeding but.i try to remind myself.that a deep stick.would have been painful.and even painful for the.next few hrs. I pressed a lot on my hands and didnt feel any spot to be tender which.leads me to believe it was not.deep. Also I know.that with a 23 gauge butterfly needle my chances are even better. Thank.god.it wasent an 18 gauge!! Also he.had a low viral load since 2001. I know I have the.upper hand here, but its scary none the less.  Infectious dr stopped the kaletra due to horrific side effects and put me on two others, in addition to.truvada. Am I correct in thinking.that the 0.3 is without pep so since im taking.it (80%) effective, that should put me.close.to 0.1% chance? Thank.you dr. merry.christmas to you and your family!

[Mommy2one2007]

also I am curious as to what is considered to be a deep stick? anything that draws blood from the injury, or with the needle going in lets say a quater of an inch? how deep is deep?
thank you for all of your help.

[Edward W Hook, MD]

Welcome to the Forum.  I have been in a similar situation an now what goes through your mind when you experience an event like this.  You have done everything right and your risk for infection is minimal.  The reasons I say this are multiple.  They include:

1.  This was not a deep needle stick.  The most dangerous sticks are the ones that draw blood.  It sounds as though you may not have even broken the skin.  If this is the case (I realize it is hard to know but don't let your mind run away with itself) there is virtually no risk.

2.  The patient was on antiretroviral therapy and his HIV virus was suppressed.  The infectivity of HIV is related to the amount of virus present and that this patient's virus was low is a very good sign.

3.  You were started on good anti-HIV therapy VERY quickly. This too serves to dramatically reduce your risk of infection even further.

The AVERAGE risk for HIV following a needle stick is 0.3% (3 infectious out of a thousand.  Your risk is far lower than this for the reasons I mention above.  Try not to worry.  EWH