Occupational exposure... risk assessment?

[freckles04]

Hello,

I'm badly in need of advice from someone.

I had an occupational exposure 19 days ago: a dried fleck of blood went into my eye from a very ill end-stage AIDS patient. The ID doctor on staff felt that I needed PEP due to the patient's history. The fleck of blood was dried, however, had likely been kept somewhat moist as it was under a dressing (when I removed the dressing, the fleck flew into my eye).

I started PEP (Viread, Emtriva and Isentress) about 12 hours after exposure, so I'm on my 18th day (feels like MUCH longer). I did have a negative HIV test and normal baseline bloodwork prior to treatment.I have had multiple symptoms/side effects from the medications as well as a HUGE amount of stress and anxiety. I have no idea which symptoms are actually side effects, which are just me slowly going insane... and I'm overanalyzing every symptom wondering if it's symptoms of HIV.

Nausea and constipation (I know, it's usually diarrhea?) started right away, along with malaise, fatigue, headaches, and just feeling awful in general. My bones and joints pop and crack at every movement, and I have muscle aches and joint pain. I walk like an old person now. The headaches are rough, and it hurts just to move
my eyes. I'm also usually cold-natured and sleep with an electric blanket. Now, I'm constantly warm, and at night, even with no covers or a light sheet, I wake up drenched in sweat ... the sheets are wet, and I have to change everything I'm wearing (not to give too much info, but I don't sleep in much as it is).

About 8-10 days into PEP, I became miserably ill and had to spend 4 days on my couch. I can't really describe what it was other than flu-like. The highest my temperature read was 99.8, but I had chills and that constant hot-then-cold feeling. I hurt everywhere and could not get comfortable in any position. I slowly recovered from that. I did receive a flu shot this past October. Of course, my first thought was that the PEP wasn't working and I was an early seroconverter...

I was hanging in there until 3 days ago, when I noticed I had a very achy right neck/shoulder. I was trying to gently rub out the pain when I felt two swollen lymph nodes in the deep cervical area. They have remained the last 3 days and are very tender to touch. I also have two pea-sized nodes on both groins, but those are painless. (I'm not poking at 'em, really! Trying to leave them alone.) I've never experienced this before. The pain has gotten worse; I'm having a constant, severe headache where my skull meets the neck, with pain in my neck and shoulders, much more concentrated on the right where the swollen nodes are. Tylenol isn't touching it. I'm considering going to a walk-in clinic today (as it's Sunday, and I could not get in to see my doctor until Thursday). I can barely move my head at this point and needed co-workers to cover my shift today. I'm thinking it could be coincidental and just some sort of infection, but I'm afraid the doctors will hear I was exposed to HIV recently and dismiss everything and maybe tell me, "Yep, sounds like you've got HIV. Nothing we can do for you."

I know the symptoms of HIV and it feels like I'm ticking the boxes as time passes. I feel like the only thing I haven't experienced is a true fever, and I haven't had any rashes that I've noticed (yet).

I had bloodwork done last week which was normal, except for slightly elevated liver function tests. Not enough to stop taking the PEP according to the doctor who reviewed them at the employee health clinic.

A scenario constantly plays through my head that with the patient's history, maybe the PEP is not working due to resistance or some other factor. I've read that my risk of exposure is 0.09% with a blood splatter to the eye, and likely mine is less due to it being dried blood, but I can't shake the worry. Everytime I think I can deal with it and I'm going to be okay, I get some new symptom that causes me to be scared again.

Deep down:
-I'm terrified I'll feel this way the rest of my life.
-Terrified I'll never be able to work as an HIV-positive healthcare professional. The stigma is very alive and real, even today. I've been chastised in the past for touching a patient's intact skin without gloves... a patient who had no history of HIV, but the co-worker felt he "might" have it because he was gay (I did attempt to educate this co-worker, but sometimes, you can't fix stupid.)
-Terrified my friends and co-workers will reject me... maybe even some of my family.
-I feel like I'm already grieving for my old life.
-I want to just get out there and STAY BUSY with something else, but I have no energy and feel so sick that I sit here with nothing to do but think about this. I guess I just needed to get that out there to anyone who will understand what I'm going through, and hear an honest risk assessment. Maybe a good slap in the face is needed. Tell me I'm a moron for even worrying about it.

If nothing else, this has raised my awareness of HIV to a new level. If anyone knows of a legitimate research fund to which I could begin donating, please post it. I've googled, but the results are a little overwhelming.

Thanks to anyone who read this novel of a post and takes time to reply.

[RapidRod]

HIV is not transmitted in that manner. HIV is unable to reproduce outside its living host (unlike many bacteria or fungi, which may do so under suitable conditions), except under laboratory conditions; therefore, it does not spread or maintain infectiousness outside its host.

[jkinatl2]

Of the three cases I found where it was suggested that blood in the eye might have led to seroconversion, it was fresh arterial blood shooting into the eye of a healthcare worker. What you describe is absolutely not that. Blood containing HIV does not need to be dry before it loses the capacity to infect. HIV is a very fragile virus and can absolutely not remain infectious once outside the body in the manner you described.

You did not require pep and stand no chance of seroconverting over this no risk event.