Dr. MJ Bazos MD,
to HIV: Advice for Health Care workers
How can HIV be
Blood, semen, vaginal secretions, vomitus,
breast milk or pus from a person with HIV (human immunodeficiency virus)
infection may transmit the virus. The risk of acquiring HIV from a needle-stick
injury is less than 1%, and the risk of infection from exposure not involving a
puncture or a cut (such as a splash of body fluid onto the skin or the mucous
membrane) is less than 0.1%. The risk of HIV infection from a human bite is
between 0.1% and 1%.
"Clear" body fluids such as tears, saliva, sweat
and urine contain little or no virus and do not transmit HIV unless they are
contaminated with blood.
What should I do
if I think I have been exposed?
If a skin puncture has occurred, induce bleeding
at the puncture site by applying gentle pressure as you wash the area with soap
and water. If skin or mucous membranes have been splashed by body fluid,
immediately rinse the area thoroughly with water.
Get the name, address and phone number of the
source person (patient) and the name, address and phone number of the source
person's attending physician. If you do not know the patient's HIV status, ask
the attending physician to help. If you are at work, notify your supervisor. Do
not spend time now on details of how or why the exposure happened. There will be
time for this later.
When do I first
need to get medical care?
Seek immediate assessment and treatment from
your employee health unit, your private physician, or the emergency department.
If anti-HIV medication is indicated, it should be taken as soon as possible. If
you have a skin puncture or cut, you might need a tetanus toxoid booster,
depending on the nature of the injury. Your physician will need to ask questions
about the incident and other details in order to determine what treatment, if
any, is necessary.
What details will
I need to give my physician?
For a puncture injury--Is it a deep or
surface puncture? If the puncture was caused by a needle, what gauge was the
needle? Was the needle solid (suturing) or hollow? Could you see blood or bloody
material on the surface of the needle or scalpel? Was the device previously in
the patient's vein or artery? If blood was injected into you, how much? Were you
wearing protective gloves?
For a skin or mucous membrane
splash--Were you exposed to blood or other body fluid? How much? On what
part of the body were you exposed? What size was the area of contact? What was
the length of contact time? Was there a break in the skin? A rash? A bite? Were
you wearing protection (e.g., gloves, eyeglasses)?
What will my
physician need to know about the source person?
The HIV status of the source person--If
the source person is HIV negative, he or she could be infected but may not yet
have positive HIV tests (he or she may be in the "window" period). Will he or
she agree to be tested or retested for HIV infection?
If the source person is HIV positive, does he or
she have AIDS? Has the source person taken anti-HIV therapy? If so, what
medications is he or she taking? Is he or she at the end stage of the disease
(with a high quantity of virus in his or her blood and body
If the source person will not agree to HIV
testing, whether he or she is in a high-risk HIV group--Is the person an
intravenous drug user or the sexual partner of an intravenous drug user, a
bisexual or homosexual male, and/or a person with multiple partners? Did he or
she receive a blood transfusion between 1980 and 1985? Has he or she received a
blood transfusion recently?
What will I need
to tell my physician about myself?
Information about any medical conditions,
medications and allergies--Have you been exposed to HIV before? If so, when?
How? Are you pregnant? Are you breast feeding? Are you sexually
Whether you will agree to testing--Will
you agree to confidential testing in order to document seroconversion (in the
rare event of HIV transmission by occupational exposure)?
Should I receive
post-exposure HIV prophylaxis?
Based on answers to the questions above, your
physician may advise you to take medication to reduce your risk of developing
HIV. Your doctor may also give medicine to protect you against hepatitis and
syphilis. You will need baseline blood work, especially for evaluation of bone
marrow, liver and kidney function. These tests will be repeated during the
course of therapy.
Early postexposure prophylaxis can reduce the
risk of HIV infection tenfold. Even if infection occurs despite prophylaxis,
early suppression of the virus can lower the "set point" for viral load and slow
the course of HIV disease substantially.
treatment have side effects?
Some of the medicines used can cause side
effects. For example, zidovudine (brand names: AZT; Retrovir) may cause
headache, fatigue, insomnia and gastrointestinal symptoms (nausea, diarrhea,
abdominal discomfort). In rare instances, lamivudine (brand name: Epivir) may
cause pancreatitis and gastrointestinal symptoms. Indinavir (brand name:
Crixivan) and saquinavir (brand name: Invirase) may cause gastrointestinal upset
and diarrhea. Indinavir has also been associated with kidney stones. Two quarts
of fluid should be taken daily to reduce this risk.
How can I protect
others from possible exposure to HIV?
Until HIV infection is ruled out, you should
avoid the exchange of body fluids during sex, postpone pregnancy, and refrain
from blood or organ donation. If you are breast feeding, your baby's doctor may
ask you to switch to formula feeding.
When should I be
retested for HIV?
HIV testing may be repeated at 6 weeks, 3 months
and 6 months. Nearly all people found to be negative at 3 months are confirmed
to be uninfected. However, the Centers for Disease Control and Prevention
recommend retesting up to 6 months following the last possible exposure. If you
have not formed antibodies to HIV by 6 months, then infection did not occur.
Until then, you should report and seek medical evaluation if you have any acute
illness. An acute illness, especially if accompanied by fever, rash or swollen
lymph nodes, may be a sign of HIV infection or another medical
How can I cope
with my feelings?
It is natural to feel anger, self-recrimination,
fear, embarrassment and depression after occupational exposure to HIV. During
the difficult time of therapy and waiting, you may want to seek support from
employee-assistance programs or local mental health