Possible needle stick

[PaulKemp]

Recently I was unfortunate enough to have been possibly stuck with a needle. Yes, I know- possibly. my mind is racing and normally I am an anxious person, so.... 

 

I've also been getting conflicting information from different doctors so here I am. 

 

I am on PEP now, since maybe 48 hours after the incident. My liver and kidney function was not tested before. I was also given a PCR about 36 hours after exosure, which was of course negative.

 

I have been drinking heavily for about two years before anc I am concerned about the toll PEP will take. I've been told that the drugs are both hard on thee organs and also that there are no side effects. Dr. at the Anon clinic said kidney and LFT will need to be checked after the 28 days of PEP. Confusing. 

 

Thw bottom line is that I don't know fhe risks of continuing taking PEP considering the needle stick incident was never verified. 

 

Any advice?

[Sheryl]

Baseline liver function test would have been advisable especially given  your history of drinking.

 

I would suggest getting them done now - ALT and AST, any hospital  or lab can do and no need to fast beforehand. If they come back elevated best to consult a doctor.

 

Impossible to assess the risk of the needle stick without more information i.e. a needle from where, that had been used for what etc.  Main risk is with needles with fresh blood on them, such as occurs when drug users share needles, the risk of transmission from that is very, very high.

 

Needles that were not used intravenously - for example, needles used in intramuscular injections - are much, much lower risk.

 

Don't forget the risk of hepatitis, that is greater than HIV and the PEP won't help that.  Get a Hepatits panel done within a few weeks.

[PaulKemp]

Thank you, Sheryl, as always for the good advice. 

Ive done both the ALT and AST which came back middle of the reference ranges at RSU. Seems like everything is fine. I'll be doing the Hep tests soon- Im thinking after the PEP, 4 weeks- is this a good course of action? 
I've already been vaccinated for Hep A and B about 10 years ago. Not sure how often you need to renew these.... 

It always feels strange to me to consult a message board for health advice, but it seems that here in Thailand there is so much variability in quality of doctors that it is almost necessary. 

[Sheryl]

Sounds good.  And good that you had the Hep B vaccine. When you get the hepatitis panel, make sure they check for both surface antigen and antibodies of Hep A B (this is standard for full hepatitis panels, but just as well to specify) and also at least Hep C antibody. This will not only tell if you have recently acquired  hepatitis (surface antigen Hep a or B will be positive) but also whether you are still protected against Hep a and B (antibody level). There is a lot of uncertainty/controversy re the need for booster doses of that vaccine, but by measuring the antibody level you can know for sure if it is advisable in your case. (In the US, no booster is recommended for people with normal immune systems; in the UK, a single booster 6 years after the original series is recommended; in some other places they recommend testing for antibody titers and goingby that).

 

Hep C active infection is harder/more expensive to diagnose and most Hepatitis panels will just check for antibodies. If those are positive then other tests, such as Hep C DNA-PCR would be indicated but they are costly and if you are antibody negative 4 weeks post exposure then I wouldn't bother.

[PaulKemp]

Thanks! 

Ive since completed PEP with no complications, and went for an HIV antibody test about 7 weeks post exposure (3 weeks post PEP).  NEGATIVE. (Phew!)

I've been reading that all tests should be done on a timeline that considers the first day after completing PEP as "day zero" so to speak. This means I will have to take another antibody test at 12 weeks post PEP and not post exposure? 

Anyway, since Ive done a CBC just days before I took the HIV antibody test which came back a little odd.
WBC differential; 
Neutrophils - 75.9% (46.5-79.0) flagged as high
Lymphocytes - 1332 L (1500-4000) flagged as low

In addition to that I've been having weird symptoms that, according to Dr. Google, could be concerning. Good ole' Dr. Google. Anyway, the bottom line is that I'm still concerned. Could it be that the PEP weakened my immune system to produce these results? 

I guess the question that I have would be this- should I go ahead and just do a PCR from the Anon Clinic to get definitive results re:HIV? Will that be as good as waiting 12 weeks, and then 6 months post PEP to find out if I am in the clear via HIV antibody test? 

 

[Sheryl]

A PCR is not reliable when you have been on PEP as PEP can drive your viral levels too low to be detectable.

 

Antibody tests at four- six weeks, three months and six months from the date of exposure is the US CDC recommendation. WHO recommendation is about the same except they skip the third test and rather make the second test "3 - 6 months" after exposure.

 

Bear in mind that in your particular case the exposure was so questionable that the risk is infinitesemially small.

 

WBC differentials are of no significance if the overall WBC count was normal. The machines will automatically churn out "high" or "low', but it can be ignored.