Impact of Delayed Blood Test Results on HIV Exposure Risk After Needlestick

Q: Impact of Delayed Blood Test Results on HIV Exposure Risk After Needlestick

Hello： There is no immunoglobulin available to prevent HIV, but there are oral post-exposure prophylaxis (PEP) medications. <br>It is recommended to first inquire verbally or check cloud-based records to see if the patient has any bloodborne infectious diseases. <br>If it is conf

Does it matter if the test results are obtained more than 24 hours after the needle puncture?

During surgery, I was accidentally punctured by a brand new needle, which immediately drew blood.
However, my gloves had already come into contact with the patient's blood.
Blood was drawn in the hospital after the needle stick, but the test results will not be available for two days.
I would like to ask: (1) If the test results come back positive for HIV after two days, which is beyond the recommended time frame for administering post-exposure prophylaxis (PEP), what should I do next? (2) Given my situation, what is the likelihood of infection? Thank you, doctor.

Xuan, 20~29 year old female. Ask Date: 2021/08/10

Dr. Lin Wufu reply Internal Medicine

Hello: There is no immunoglobulin available to prevent HIV, but there are oral post-exposure prophylaxis (PEP) medications.
It is recommended to first inquire verbally or check cloud-based records to see if the patient has any bloodborne infectious diseases.
If it is confirmed or highly suspected that the patient is HIV positive, then oral medications for post-exposure prophylaxis can be administered.
It is advised to use PEP medications within 72 hours for them to be effective.
Even if the patient is confirmed to have AIDS, they must have a high viral load that is uncontrolled to pose a significant risk of transmission.
Even so, the risk of transmission from a single needle stick is approximately 1%.
Moreover, since this patient is not a known AIDS patient, the overall risk of infection is very low, so there is no need to worry too much (but it is still important to confirm the patient's final blood test results, not just rely on your own test results).

Reply Date: 2021/08/10

More Info

When it comes to the risk of HIV transmission following a needlestick injury, several factors must be considered, including the timing of testing, the nature of the exposure, and the subsequent actions taken after the exposure.
1. Delayed Test Results and Post-Exposure Prophylaxis (PEP): In your situation, where you were pricked by a needle that had already been in contact with a patient's blood, it is crucial to act quickly. The Centers for Disease Control and Prevention (CDC) recommends that post-exposure prophylaxis (PEP) be initiated as soon as possible, ideally within hours of exposure, and certainly within 72 hours. If the test results indicating the patient's HIV status are delayed by two days, and if the patient is found to be HIV positive, you may have missed the optimal window to start PEP. However, it is still essential to consult with an infectious disease specialist or your healthcare provider immediately upon receiving the test results. They can assess your risk and determine if PEP is still appropriate based on the nature of the exposure and the patient's viral load.

2. Risk of Infection: The risk of HIV transmission from a needlestick injury varies depending on several factors, including the type of needle, the volume of blood involved, and the HIV status of the source patient. According to the CDC, the estimated risk of HIV transmission from a needlestick injury is approximately 0.3% (or 1 in 300) if the source is HIV positive. However, this risk can be influenced by factors such as whether the source patient is on antiretroviral therapy (ART) and has an undetectable viral load, which significantly reduces the risk of transmission.

In your case, since the needle was new but had already been exposed to the patient’s blood, the risk of transmission would depend on the HIV status of that patient. If the patient is HIV positive and not on effective treatment, the risk could be higher. If the patient is HIV negative or has an undetectable viral load, the risk is negligible.

Next Steps: After a needlestick injury, it is crucial to follow these steps:
- Immediate Care: Wash the area with soap and water. Do not use alcohol or bleach.

- Report the Incident: Notify your supervisor and follow your institution's protocol for needlestick injuries.

- Testing: Get tested for HIV and other bloodborne pathogens as soon as possible. Follow-up testing may be necessary.

- Consultation: Speak with an infectious disease specialist about the need for PEP and any other necessary interventions.

In summary, while the delay in test results can complicate the situation, it is essential to seek immediate medical advice upon receiving the results. The risk of HIV transmission from a needlestick injury is relatively low, but it is not negligible, especially if the source patient is HIV positive. Prompt action and consultation with healthcare professionals can help mitigate the risks associated with such exposures.

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