Am I infected?

[Nusefin]

Hello all,
I am a nurse working in the emergency room. Last September, I suffered a needle stick injury from a HIV positive patient. I'm unsure exactly how it happened, but it happened. I was inserting an IV, when I think I got stuck with the vaccutainer that had miminally amount of blood on it. The patient has had HIV since 2010 and currently takes genvoya. He stated he was undectable. I was immediately put on PEP within 1.5 hours with a 3 drug cocktail. My organization never tested his viral load count. I tolerated PEP well and never missed a dose. I had my 6 week rapid HIV test which was negative, a 3 month rapid HIV test which was negative and a 6 month raipid HIV test which was negative. I completed PEP October 22nd and tested negative April 4th that being my last test. I have not been ill, or have any strange symptoms, however I still occasionally worry I could be infected. Are rapid tests just as accurate than standard? The rapid test my organization utilizes is whole blood and 3rd generation. I know the source patient is still alive because he still comes into the ER.

Thoughts?


Thanks so much in advance

[Jim Allen]

My thoughts are you have conclusively tested negative.

To be honest i did check and could only find that since 1996 there have  been about 125 reported incident of needle stick injury resulting in HIV transmission for the entire USA. So very low low risk, given the number of times needle stick incidents do happen.

BBV guidelines last time I checked even with PEP was reduced to only 4 months test result for a conclusive result in healthcare settings, this even with 3rd gen testing.

To be honest 3 months is normally conclusive, with or without pep its simply unheard to test positive after that length of time in this day and age without a underling health issue.

https://www.cdc.gov/niosh/topics/bbp/guidelines.html

Jim

[Nusefin]

How accurate is oraquick in home hiv testing kit? It has been 11 months since my exposure and I just tested negative with it. I have had a rapid done at 3 and 6 months both negative. I tested today because my anxiety was killing me - again negative.

Thanks

[Ptrk3]

Your question has been asked and answered previously and I have merged threads.

Please do not ask your question again.

Your test is negative, you have repeatedly tested conclusively negative, and you have completed a PEP regimen.

You are "negative" as a result of the incident you described in your original post.

If you can't accept this fact, work with your healthcare provider to explore options on how best to deal with your anxiety.

[Jim Allen]

Don't even post 

I can see you reading and with that thinking about it, false negatives have been linked back to either testing too soon, incorrectly home test users or people with underling medical conditions and even this is freakishly rare a few per 1000

To put it this was even on older rapid tests the first- through third-generation were all perfect at correctly identifying HIV-negative cases, except for the OraQuick Advance rapid saliva test, which was 99.9 percent accurate in one study.

So as long as you have no underling medical reason for a severally suppressed immune system or test before the window period of 3 months the results are conclusive.

Jim

References:

(Generation 1/2/3)
Pilcher CD et al. Performance of Rapid Point-of-Care and Laboratory Tests for Acute and Established HIV Infection in San Francisco. PLOS ONE, 2013.
Branson BM State of the art for diagnosis of HIV infection. Clin Infect Dis 45:S221-225, 2007
Coombs RW Clinical laboratory diagnosis of HIV-1 and use of viral RNA to monitor infection. In Holmes KK (editor), Sexually Transmitted Diseases. New York: McGraw-Hill, 2008
Maldarelli F Diagnosis of Human Immunodeficiency Virus infection. In Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases (sixth edition). Philadelphia: Elsevier Churchill Livingstone, 2004
Parry JV et al. Towards error-free HIV diagnosis: guidelines on laboratory practice. Comm Dis Pub Health 6:334-350, 2003
Jim comment- This is on 3rd gen testing accuracy Perry KR et al. Improvement in the performance of HIV screening kits. Transfus Med 18:228-240, 2008

(Gen 4)

Bentsen C Performance evaluation of the Bio-Rad Laboratories GS HIV Combo Ag/Ab EIA, a 4th generation HIV assay for the simultaneous detection of HIV p24 antigen and antibodies to HIV-1 (groups M and O) and HIV-2 in human serum or plasma. Journal of Clinical Virology, S57-S61, 2011
Nick S Sensitivities of CE-Marked HIV, HCV, and HBsAg Assays. Journal of Medical Virology, S59-S64, 2007
Eshelman S Detection of Individuals With Acute HIV-1 Infection Using the ARCHITECT HIV Ag/Ab Combo Assay. Journal of Acquired Immune Deficiency Syndromes, 121-4, 2009
Speers D et al. Combination assay detecting both Human Immunodeficiency Virus (HIV) p24 antigen and anti-HIV antibodies opens a second diagnostic window. J Clin Microbiol 43:5397-5399, 2005
Ly TD et al. Evaluation of the sensitivity and specificity of six HIV combined p24 antigen and antibody assays. J Virol Methods 122:185-94, 2004