Dr. Basti Bharatesh Devendra
Dermatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Please check the two pictures I have sent, the little wound on the finger is my daughter's. The big wound is our friend's wound. My daughter had a small wound on her finger that I had not seen and had not put a band-aid on it, and we were visiting some friends. One of our friends had a big bloody wound on his finger which he showed us, he did not have a band-aid and I took a picture of his wound. Now to my great concern, my child played with him a lot and I am worried that their wounds touched each other. We do not know anything about his blood status but he is a careless type so I am worried. Now my question is:
If my daughter's wound and his wound came into contact with each other and he has HIV. How much percent is the risk of HIV infection in this scenario? Is the risk zero? Should I test my daughter? Kindly suggest.
Hello,
Welcome to icliniq.com.
I have gone through the photos and details (attachment removed to protect the patient's identity), and understand your concern. If the child's wound was covered with a band-aid, the chances of the wound coming in contact with the person's blood would be nil. Not all people are HIV (human immunodeficiency virus) positive. If you can know his HIV status, it would be good. The wound may be eczema or a healing wound. It need not be bleeding at the time of contact. Moreover, it need not come in contact with the child's wound. If the child is covered with a band aid no need to worry about HIV. If the child's wound is not covered there may be remote possibilities of transmission of HIV (if his wound was bleeding and came directly in contact with the child's wound). In my opinion, the risk is very low to almost nil. You can please consult your doctor for further risk assessment and management.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
My child did not have a band-aid. I realized when we came home, I did not know she had a wound. She is just three and played a lot with him. I will send more pictures of my daughter's wound. Please suggest how much is her risk. Our doctor is on vacation for some months but please let me know how much is at risk in this case. If it was your kid, would you go for testing or would you consider the risk as nil? Please, doctor, have a look at the pictures of her wound, is her little wound big enough to be at risk? Kindly suggest.
Hello,
Welcome back to icliniq.com.
I have read your concern and understand your concern. Practically, in my opinion, the risk is almost nil. Theoretically, remote possibilities of transmission of HIV (human immunodeficiency virus) are possible if he is HIV positive and comes in contact with the wound, which is very unlikely. The child's wound can act as a portal of entry for HIV if exposed to the HIV virus. The child is very unlikely to be exposed to HIV by the given explanation. If possible, get his HIV status. If he is HIV negative no need to worry at all. If he is HIV positive then consult your doctor for further risk assessment and management.
I hope this helps you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
Unfortunately, we cannot ask about his status as our friendship is limited. But I will describe a little more to clarify for you so you can give me a more specific risk assessment. The game they played was him carrying my child and running around playing with her. He had blood in his wound but the blood did not flow but was in the wound, neither my child nor he had band-aid. Please see my daughter's wound and his wound again from the previous picture. What may have happened is that their fingers may have touched each other. Can an infection occur even if the person's wound has blood in it and the blood is not flowing out? I mean he was not actively bleeding, he had blood in the wound. He had gotten this wound through the following: a mosquito had bitten him and he had an allergic reaction with a blister. He stuck a needle in the blister some hours before we met and then the wound with blood in it. So if both wounds have touched each other without blood flowing from his wound, even though he has blood in the wound, can it still be infected? If they have not rubbed the wounds against each other but only touched each other in play, how big is the probability of infection? Is there nil risk? Would you have let it go if it was your child or would you have taken tests?
Kindly suggest.
Hello,
Welcome back to icliniq.com.
I have read your query and can make out your anxiety. As I have said earlier, practically the chances of transmission of HIV in this scenario is nil, even if the person is HIV positive. Theoretically, the possibility of transmission of HIV is possible but remote. If he is HIV negative for sure there is no chance of transmission. I suggested confirming his HIV status so that you can be relieved of anxiety totally. Nothing needs to be done. If he is HIV positive then it would be better to consult your doctor for further assessment and management. If needed PEP (post-exposure prophylaxis) may be initiated (if the exposure is within 72 hours.). In my opinion, PEP would not be required for this exposure. HIV tests can be done later even after three months of exposure. I hope you find this helpful. Thank you.
Patient's Query
Hello doctor,
Thank you for your prompt reply.
We cannot ask him about his status, he is not the one who does tests at all. And he is a friend through a friend so we cannot ask him. We must accept that we do not know his status. He may be negative and he may be positive we do not know. Please I am very confused now, if he only had blood in the wound and not running blood and if they only touched each other's wound without rubbing is it still a risk? How can viruses enter if they only touch each other? Is my kid's risk nil? If the risk is nil, then why should we test after three months? Please help me out. I am very confused.
Hello,
Welcome back to icliniq.com.
I have read your query and understand your concern. Intact skin is an effective barrier for HIV. But there is a wound in the child's finger and it is not an old healed wound. This can act as a portal of entry for HIV if exposed to HIV. HIV virus size is in nanometers. The person's wound has blood but is not bleeding actively. So practically the blood from his wound reaching the child's finger wound is remote. So the chances of transmission of HIV are practically nil. Theoretically, it is possible but chances are remote. If there is any likely risk of exposure to the HIV virus, PEP (post-exposure prophylaxis) for HIV is initiated as early as possible, but not later than 72 hours of exposure. It helps in the prevention of HIV transmission. After 72 hours of risk exposure, there is not much benefit to initiating PEP. Then HIV tests help in diagnosis. It can be done later. HIV antibody test after 90 days of exposure is considered a conclusive result. So after 90 days of exposure, HIV antibody tests on a child help in conclusive results and will relieve your anxiety totally. I hope I have cleared all your doubts.
Thank you.
Patient's Query
Hello doctor,
Thank you again for your time; I greatly appreciate it.
Please start by reading my first question I have sent earlier to remember what this is about and you are welcome to look at the pictures. Now to my question: You have told me before that the risk of HIV transmission in this scenario is practically zero, its nil. The problem is my child is now sick alone, usually if she gets sick her brother or someone of us gets also sick but not this time. It has been 3.5 weeks since I suspect her wound may have come into contact with his wound. Her symptoms are as follows: it started with a dry cough, fever and sore throat. After one day she also got eye infection. The fever and sore throat lasted for one day. The eye infection went away in two days. But the dry cough is still there now after four days and has become much worse, I read everywhere that dry cough is symptom of acute HIV infection. My points of concern are as follows:
Could this be an acute HIV infection even though you said her practical risk of infection is nil? I am worried because none of us are infected. I even touched my eyes after touching hers hoping to get infected. I went near her when she coughs and sneezes, but I do not get a cold or an eye infection. It strengthens my concern. Is eye infection symptom of acute HIV infection?
Hi,
Welcome back to icliniq.com.
I can sense your anxiety. I have gone through the details. As I have said earlier, the chances of HIV transmission are almost nil. The symptoms are nonspecific and may not be related to HIV; they could be caused by any respiratory infection due to contact with any person. Anyway, as I suggested earlier, please go for an HIV antibodies test now (for the child) and after 90 days from the last exposure to be completely relieved of anxiety and obtain conclusive results. Please consult your doctor for an examination and management of symptoms.
Patient's Query
Hi doctor,
Thank you for the reply.
We must go through our family doctor for everything. He said no tests are needed. I do not know what to do since the doctor was not an HIV expert like you; he is just a general doctor, and he refused. I tried to make him understand, but he still said no tests are needed. I am so worried for my child. But please, one more question: Is eye infection a symptom of acute HIV infection?
Hi,
Welcome back to icliniq.com.
As I have said earlier, the chances of transmission of HIV, given the description, are almost nil. Practically nil. But I can understand your anxiety. So, consider the test to alleviate your anxiety. A single eye or respiratory infection is nonspecific; it can be due to any infection and need not necessarily be related to HIV. This is unlikely in the child as well. So, just relax and follow up for the management of these symptoms with your doctor.
You can always come back and reach me at icliniq.com.
Thank you for consulting me.
Patient's Query
Hello doctor,
Thank you again for your time; I greatly appreciate it.
We went to the doctor again today because my child got hives on her leg. She has a fever, swollen lymph nodes, a sore throat, dry cough, eye inflammation, irritated ear, and hives on her leg. But the doctor still refuses an HIV test, saying it's a viral infection. Doctor, she has never had hives from a viral infection; her hives on her leg were only there for one hour and then disappeared. I sent pictures to you. Is it true that during Acute HIV, people get a rash and not hives? How long does the acute HIV rash stay? These hives were only there for one hour. Is the risk of transmission higher now due to the hives, or do you still think the practical risk is nil? It has been four weeks since I think her wound came into contact with his wound, and she has been sick for a week now. Please check the new picture of the hives.
Hi,
Thank you for the follow up query.
The attached photo is not opening or not uploaded properly. Please contact customer care for help regarding photo upload. If your treating doctor has ruled out HIV, you should be happy and relaxed. If the rash has disappeared, it may probably be due to hives or urticarial rash. So you need not worry and link it to HIV. Meanwhile, if possible, you can go for an HIV antibodies test anytime after 90 days of probable exposure to be relieved of anxiety.
Patient's Query
Hi doctor,
Thank you for the reply.
I have attached the picture again. Can you please check now? I see that you are able to open it now. What do you think about what you see? I pay a lot to get my questions answered because I really appreciate your knowledge. But please answer this question:
Hi,
Thank you for the follow up query.
I am still unable to see the attached photo. Maybe the format is not compatible or there are other issues. Please contact customer service for help with the upload. I do not think you need to pay for it. Moreover, if the rashes are transient, it is more likely due to hives. Hives are transient rashes caused by an allergic response of the body. These are not HIV rashes. Even though HIV rashes are not typically described as such, they stay for a few days and are not transient. Please do not relate it to HIV.
You can always come back and reach me at icliniq.com.
Thank you for consulting me.
Patient's Query
Hello doctor,
Thank you for your prompt reply.
Please check this new picture. My daughter's body is still itching. During the evening, she again had a little of this rash on her face and then it went away; they disappeared. She says her whole body is itching, which she never said before. She has a sore throat, dry cough, eye inflammation, swollen lymph nodes, and an itching body. I went to the doctor again, still refusing a test. Please help me.
Hi,
Welcome back to icliniq.com.
I have gone through the photos. The rash is likely due to allergies or hives. Not all sore throat ,rashes are due to HIV. These can be due to any infection or allergies . Even i do not feel it is due to HIV. So do not relate it to HIV. Your treating doctor is the best judge as they examine the patient as a whole. Follow the treatment/advices of your doctor. So do not worry. If your treating doctor is confident then there is nothing to worry. They might have seen similar infection or allergies in that place.
Patient's Query
Hi doctor,
Thank you again for your time; I greatly appreciate it.
My treating doctor says that HIV cannot be passed through skin-to-skin contact, which is not true. I do not believe her judgment. Please let me know: does acute HIV cause eye infection? Does acute HIV cause itching in the whole body and a rash like this that comes and goes? I mean, she says all the time my body is itching and the rash comes and disappears after 1 hour. Please, doctor, I do not want to lose my daughter.
Hi,
Welcome back to icliniq.com.
Yes. Intact skin is an effective barrier for HIV. So intact skin to skin contact the transmission of HIV is nil. There is a slight breach of skin in both, but there is no active bleeding in both. So the risk is almost nil. The symptoms (rash or eye infection) are non specific and can be due to any infection or allergies and need not be HIV. So you need not worry about HIV. As you are too anxious I wanted you to go for HIV tests, so that you will stop worrying about it.
Patient's Query
Hello doctor,
Thank you for your prompt reply.
Please see the earlier conversation and pictures. Around 1.5 months ago, my little daughter played with someone who had a wound, and my daughter also had a little wound without a band aid. Anyway, she got strange symptoms after 3.5 weeks, and you advised taking a test after 90 days. After many tries, the doctor here took a test after 4 weeks, which is too early. The test is 4th generation, and the doctor doesn't want to take another one after 90 days, but I will try my best. Now, 7 weeks after that incident, she has one swollen lymph node under her arm. Can this also be a symptom? I have sent the picture. I only have one question: is what you see in the picture considered swollen lymph nodes, or is this the normal size of lymph nodes?
Hi,
Welcome back to icliniq.com.
Please do not worry about HIV. I hope the 4th generation test is negative after four weeks. It is considered conclusive by many. I do not think you need to worry about HIV with the given risk exposure. There may not be a need for further HIV tests. I have gone through the photo. There is swelling in the axilla area. It may be due to any infection. It need not be a lymph node due to HIV. It has to be examined by your doctor. They may prescribe antibiotics, topical or oral. Please do not link every symptom with HIV. Just relax.
Patient's Query
Hi doctor,
Thank you for the reply.
What other kind of infection can cause this swelling? Yes, after 4 weeks, it was negative; you told me earlier 90 days. (For example, HIV-2 takes more time to develop antibodies; anyway, how accurate is the 4th generation test at 4 weeks in your opinion?)
Hi,
Thank you for the follow up query.
Fourth generation test is very sensitive test. It can be almost more than 95 percent accurate. In your scenario there is no exposure at all to worry. HIV2 is very rare. So, do not worry about it. Any simple infection like folliculitis or skin infection in the area can cause lymph node swelling in the drainage area. So need not be HIV. Follow your doctor's advice if it persists.
Patient's Query
Hello doctor,
Thank you again for your time; I greatly appreciate it.
Please read the earlier conversation between us. My daughter still has swollen lymph nodes; it has been like three weeks now. I have checked with one doctor; they do not know the reason. Please, doctor, I feel so bad. She has never had swollen lymph nodes. There is no bacterial infection, so what can this be? My next question: She got symptoms after around 23-24 days from the exposure, and we did the test after 31 days, so 1 week after symptoms started. Would the 4th generation test show if it was an acute HIV infection? I have read that when the p24 antigen reaches its peak, it then starts decreasing, and when the p24 antigen goes down and there are no HIV antibodies yet, there is a window where a negative result is not trustworthy. Is this true?
Hi,
Thank you for the follow up query.
As I have said earlier, single-area lymph node swelling need not be related to HIV. It can be due to any infection in its drainage area. The HIV fourth-generation test is considered very sensitive by one month post-exposure. The antigens may not be very sensitive, but the antibodies start getting formed by 2 to 6 weeks, then the antigen starts reducing. So, by 1 month, one of them will usually be present in the test. The risk exposure is not a reason to worry too. In this scenario, there is nothing to worry about HIV. Just relax. Please do not link everything to HIV.
Patient's Query
Hi doctor,
Thank you again for your time; I greatly appreciate it.
So, when the antigen starts producing, the antibody also starts to produce. If the antigen is not considered to be sensitive, how can the test be so sure that there will be either antigen or antibody in the result? I mean, if there are only antigens at 1 month, is the test still 95% accurate? And the last question, which one of them is usually present one week from that acute HIV symptom start? Antigen or antibody? Some people form HIV acute symptoms after 4 weeks; in that case, the antigen is present and no antibodies. And if the antigen is not sensitive, how can the test be 95% accurate. Understanding all this helps me to relax.
Hi,
Welcome back to icliniq.com.
Please do not worry about these too much. There are a lot of issues in immunology that are not really important for you to worry about. Antigen is part of HIV. Antibodies are produced by the body towards HIV and HIV antigens. So the antigen appears first as soon as HIV starts multiplying. It takes some days for it to be detected, as HIV has to multiply. 1 week post-exposure, it may or may not be detectable. It takes some more time for our immune system to detect these antigens and produce antibodies. Usually, the time for antibodies to appear is 2 to 6 weeks post-exposure. A maximum of 90 days or 3 months is given for HIV antibodies detection. Post 90 days exposure, HIV antibodies tests, including these 4th generation tests (as they detect both HIV antigen and antibodies), are conclusive. Once these are formed, the antigen may start waning down and may or may not be detectable. But antibodies will be detected by then. By 1 month, one of these will be detected. So the 4th generation test is very sensitive and considered conclusive by many.
I hope this has helped you. Please feel free to reach me again, in case of further queries.
Thank you.
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