Needle stick at HIV testing centre

[Fonseka511]

Hi
Last September 2020 I had a needle stick injury. And I followed all the guildlines except taking pep. I refused to take it.I know it was a foolish thing but At that time I didnt worry about too much. my hiv test at 12 week is negative and again I did hiv test at 20 weeks to ease my anexety is negative. (Both tests are Ag/Ab combo tests).My fears have started now after I notice Linear gingival erythema on my gingiva a week earlier. It is confirmed by a dentist.I told him my exposure. He told me to get an anothet HIV test. should I do another test ? I'm worried and deaparate what to do next?please someone answer
Thank you.

[Jim Allen]

Hiya,

He told me to get an anothet HIV test. should I do another test ?

Sure routine testing if you are or have been sexually active is recommended, at least yearly out of standard routine.

As for LGE, it was once incorrectly thought to be directly related to HIV infection. We now know it's not as other immune issues can also cause this problem. 

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your health care provider about taking PrEP going forward as an additional layer of HIV protection.

Keep in mind that some sexual practices which may be described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get fully tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

Also, note that it is possible to have an STI and show no signs or symptoms and the only way of knowing is by testing.

Kind regards

Jim

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[Fonseka511]

Hi
I'm not sexsually active. I live in a country where sex before marriage is not allowed and considered a sin. This was my first job. Never thought this would end like this.
I want to make my mind. Should I retest?

[Jim Allen]

Hiya,

You have conclusively tested negative over the needle stick injury.

I live in a country where sex before marriage is not allowed and considered a sin.

It still happens though. So if in the future you do or have done so in the past don't get caught, use condoms if available and test yearly for STI's & HIV.

Best, Jim.

[Fonseka511]

Hello and thanks for the reply
I have a question. need your help.
The way HIV enter the body impact on seroconversion period?
ex- does sex encounter has different seroconversion period?
Does occupational exposure has different seroconversion period? Im asking this because I saw artical regarding this on internet long time ago but I cudnt find it recently.
 Does everyone seroconvert within three months regardless the exposure type? If you have any data please inform. I hope you can understand my question.
Thanks

[Jim Allen]

Hiya,

How HIV enters the body does not impact how long it takes for the immune system to develop antibodies and the testing window. In theory direct injection somewhat shorter as there are fewer barriers, but it would be a negligible difference. This has been known and seen for 30+ years now hence you will not find much specific on it.

However, studies into the window period include all routes and never found an issue. 
The only noticeable difference is when PEP & PrEP is used, it may cause a small delay regardless of the route and even that is debated though.

I'm not a librarian either, but there are plenty of studies to read about testing windows and, the lifecycle of HIV.

PEP/PrEP delay:
2015:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641668/

2017:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5578893

2017:
https://www.poz.com/article/taking-prep-contracting-hiv-may-stall-positive-test-result

Testing without PEP/PREP regardless of the route of infection:

2015
Taylor, D., Durigon, M., Davis, H., Archibald, C., Konrad, B., Coombs, D., et al. (2015). Probability of a false-negative HIV antibody test result during the window period: a tool for pre- and post-test counselling. Int. J. STD AIDS 26, 215–224. doi: 10.1177/0956462414542987

Patients typically want accurate test results as soon as possible while clinicians prefer to wait until the probability of a false-negative is virtually nil. This review summarizes the median window periods for third-generation antibody and fourth-generation HIV tests and provides the probability of a false-negative result for various days post-exposure. Data were extracted from published seroconversion panels. The median (interquartile range) window period for third-generation tests was 22 days (19-25) and 18 days (16-24) for fourth-generation tests. The probability of a false-negative result is 0.01 at 80 days' post-exposure for third-generation tests and at 42 days for fourth-generation tests.

Generation 3 & 4

http://i-base.info/guides/testing/test-accuracy-results-and-further-testing

http://i-base.info/guides/testing/appendix-1-different-types-of-hiv-test

Generation 4

2012
Rosenberg NE, Kamanga G, Phiri S, et al. Detection of acute HIV infection: a field evaluation of the determine(R) HIV-1/2 Ag/Ab combo test. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3318673/

Results. Of the participants 838 were HIV negative, 163 had established HIV infection, and 8 had acute HIV infection. For detecting acute HIV infection, the antigen portion had a sensitivity of 0.000 and a specificity of 0.983. For detecting established HIV infection, the antibody portion had a sensitivity of 0.994 and a specificity of 0.992.

2011
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222669/
Conclusions. Combo RT displayed excellent performance for detecting established HIV infection and poor performance for detecting acute HIV infection. In this setting, Combo RT is no more useful than current algorithms.

In total, 953 people underwent HIV testing. HIV antibody (Ab) prevalence was 1.8% (17/953). Four false positive rapid tests were identified: two antibody and two p24 antigen (Ag) reactions. Of participants diagnosed as HIV Ab positive, 2/17 (12%) were recent seroconverters based on clinical history and HIV antibody avidity test results. However, none of these were detected by the p24 antigen component of the rapid test kit. There were no other true positive p24 Ag tests.

https://www.cdc.gov/hiv/testing/clinical/index.html
2018
CDC recently published research findings that estimate the window period for 20 U.S. Food and Drug Administration (FDA)-approved HIV tests. The study showed that laboratory testing using antigen/antibody tests detects HIV infection sooner than other available tests that detect only antibodies. If a person gets a laboratory-based antigen/antibody test on blood plasma less than 45 days after a possible HIV exposure and the result is negative, follow-up testing can begin 45 days after the possible HIV exposure. For all other tests, CDC recommends testing again at least 90 days after exposure to be sure that a negative test result is accurate.

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

2020 http://www.bhiva.org/ https://www.bhiva.org/file/5dfceab350819/HIV-Testing-Guidelines.pdf
Recommendations (Grade 1A)

• Clinic policies and patient information regarding the HIV test window period should be based on 99th percentile estimates; where a test is undertaken sooner than this time interval, window period data should be used to counsel patients as to the likelihood of a false-negative result.

• Fourth-generation laboratory tests reliably exclude HIV by 45 days post-exposure, and this should be the window period applied when utilising these tests.

• Third-generation laboratory tests reliably exclude HIV by 2 months post-exposure, and this should be the window period applied when utilising these tests.

• POCTs reliably exclude HIV by 90 days post-exposure, and this should be the window period applied when utilising these tests.

2015 WHO http://apps.who.int/iris/bitstream/handle/10665/179870/9789241508926_eng.pdf;jsessionid=1F192FECF734A0DE7E2520864984AE63?sequence=1
In many settings post-test counselling messages recommend that all people who have a
non-reactive (HIV-negative) test result should return for retesting to rule out acute
infection that is too early for the test to detect. However, retesting is needed only for HIV-negative individuals who report recent or ongoing risk of exposure. For most people who test HIV-negative, additional retesting to rule out being in the window period is not necessary and may waste resources.

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

3rd gen testing accuracy Perry KR et al. Improvement in the performance of HIV screening kits. Transfus Med 18:228-240, 2008

[Jim Allen]

Oh and so there are no misunderstandings:

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