What Are The Chances Of HIV Infection Through Open Wound?

Posted on Sat, 20 Jun 2015

Question: hi, i am a doctor.. i have a habit of biting my nails. and i sometimes bite and remove the adjacent skin of nail. however that day there was no cut/bleeding surface on my finger but must have had bitten my nail deep enough that reddish nail bed was visible when squeezed. i had to do a per vaginal exam of a pregnant lady. i had put on gloves but while removing them, the blood and mucous got on my ring fingernail and adjacent skin of same bitten finger. i washed it immediately with soap and water. i got the lady tested and she was positive for HIV. on day 26th post exposure, i got tested with HIV combo by CMIA and it tested negative. but, i am experiencing mild fever with chills, mild sore throat from last 2-3 weeks.. the thing is when i had sore throat there was no fever, and now when there is no sore throat, there is mild fever with chills. also when i was sleeping in front of cooler, i had sore throat.i am worried now.. when do i get tested again? and can these be symptoms of ARS?

Answered by Dr. Tushar Kanti Biswas (1 hour later)

Brief Answer:
Exposure and detection of HIV infection

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
You had non-intact skin (reddish nail bed following habitual nail biting) which came in contact with potentially infectious body fluids (blood and mucous got on your ring fingernail and adjacent skin of same bitten finger).
HIV transmission after non-intact skin exposure has been documented, but the average risk for transmission by this route is estimated to be less than the risk for mucous membrane exposure.
Have you taken prophylactic combination antiretroviral therapy (cART) following exposure?
Since you are negative for HIV[most likely you have undergone the fourth-generation EIA/enzyme immunoassay tests which combine detection of antibodies to HIV with detection of the p24 antigen (window period 16 days) of HIV], you should undergo repeat testing (EIA ) after 12 weeks (antibodies to HIV generally appear in the circulation 3–12 weeks following infection) to rule out HIV infection.
An acute clinical syndrome(ARS) oocurs 3–6 weeks after primary infection and includes fever,pharyngitis apart from other constituional symptoms.
However if you are p24 antigen negative,you are highly unlikely to be suffering from ARS.
Meaanwhile you can go for HIV RNA(Reliable to 40 copies/mL of HIV RNA) by PCR amplification of cDNA generated from viral RNA (target amplification) as p24 antigen capture assay is positive in only 50% of patients(sensitivity).

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Tushar Kanti Biswas (10 hours later)

thanks doc, yes i have undergone p24ag and hiv1 and 2ab combo test.. one more thing, when do p24ag level drop? and when they drop or are undetectable, do hiv ab appear in blood at the same time or there is a window period for that also...? also i read that these combo assays are somewhat 99% accurate...

Answered by Dr. Tushar Kanti Biswas (3 hours later)

Brief Answer:
p24 antigenemia & HIV combo test

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
Throughout the course of HIV infection, an equilibrium exists between p24 antigen and anti-p24 antibodies. During the first few weeks of infection, before an immune response develops, there is a brisk rise in p24 antigen levels . After the development of anti-p24 antibodies(window period of 3-6 weeks), these levels decline(around 12 weeks following infection). Late in the course of illness, antibody levels to p24 decline, generally in association with a rising titer of p24 antigen.
HIV-1/2 Ag/Ab Combo Rapid Test has PI (performance index )Sensitivity 99.9%
- PI Specificity 99.6 – 99.8% .

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Tushar Kanti Biswas (1 hour later)

u said p24ag capture is only positive in only 50% patients.. so combining both ag and ab in test is specific or not according to you?
so my concern is how much reliable is the test i took (p24ag and HIV1 and 2 Ab combo assay)?

Answered by Dr. Tushar Kanti Biswas (21 minutes later)

Brief Answer:
Combo test for HIV

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
Immune complex–dissociated p24 antigen capture assay:Technique-Measurement of levels of HIV-1 core protein in an EIA-based format following dissociation of antigen-antibody complexes by weak acid treatment.Sensitivity: Positive in 50% of patients; detects down to 15 pg/mL of p24 protein.Below that level it does not detect p24 antigen of HIV .
Combo test (detection of antibodies to HIV with detection of the p24 antigen of HIV) usually gives the report like this:positive (highly reactive), negative (nonreactive), or indeterminate (partially reactive). What is exactly your report ?
Test on 26 th day following exposure will pick up p24 antigen but is unlikely to pick up Anti-p24 antibody (antibodies to HIV at this stage),as it may not of sufficient detectable titre (just rising).By 12 weeks following exposure Anti-p24 antibody titre will peak and will positive,if there is HIV infection..
While the EIA(enzyme immunoassay) is an extremely sensitive test, it is not optimal with regard to specificity.only 10% of EIA-positive low-risk individuals are subsequently confirmed to have HIV infection.More specific assay is the Western blot.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

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Above answer was peer-reviewed by : Dr. Yogesh D