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.
I am a 26-year-old male who is 5 feet10 inches tall and weighs about 163 lbs. I am a firefighter or paramedic working on the ambulance. Twenty days back, I had a dirty needle stick incident involving myself and a patient. The patient was a 27-year-old female who admitted to me she smokes crack. She denied any medical history. I went to use a 22-gauge IV needle on the patient and do not remember obtaining flash on the hand, but it was in the patient. I placed the needle to the side to stop bleeding from the patient. After controlling the bleed, I accidentally poked myself right below my middle finger. There was blood from the accidental stick on me. I was in the ambulance, so I was unable to wash my hands right away. I used an alcohol prep to clean it. Soon after, I arrived at the hospital and washed my hands. The patient consented to have a blood panel drawn. After I took my exposure protocol, the blood was drawn on me, and I received negative results for Hepatitis B and C, along with HIV (human immunodeficiency). The patient's test came back later, and her P24 antigen and the HIV 1 and 2 antibody rapid test both came back non-reactive (negative). Her hepatitis A, B, and C all came back negative as well. I am asking this question because roughly two weeks after the exposure; I developed a swollen left armpit that my doctor observed. My doctor was able to tell it was swollen but was unable to determine if it was a lymph node or not. About five days later, I developed vertigo that caused me to vomit. It has been four days straight that I have had vertigo, but it has been slowly getting better. Only threw up that one time. Then I started to develop what I believe is oral thrush yesterday. I have some white on my tongue. My main concern is my patient has HIV but was in the acute stage during the time, which is why she turned out negative on the test. My understanding is the acute phase of the infection is highly contagious and is where most transmissions occur. My second concern is my age, me being 27. I doubt ever there will be a cure for HIV. I am concerned antivirals will not work for me, or my body will develop a resistance to the medications, and HIV will storm back and kill me. I am terrified I will not even make it into my 40s before I die. I wanted to make it into my 60s or 70s, but I do not believe possibly being diagnosed with HIV that this will even be a possibility anymore.
Hi,
Welcome to icliniq.com.
Thank you for the query. Not all people are HIV (human immunodeficiency virus) positive, and not all who smoke or take any drugs will be positive. Moreover, her all panel tests are negative, and she is negative for HIV too. Though we cannot tell it is conclusive likely, she may not have HIV. Your medical team would have assessed your risk and would have chosen appropriately. The prick is a risk if she is positive. If not, no risk. It is good that your tests, too, have come negative. You can go for an HIV antibodies test after one month and three months of exposure to have final, conclusive results. The symptoms are non-specific and do not suggest HIV. The swelling may be due to an infection in the arm or chest area. Not all white tongue is thrush; it may be due to poor hygiene. Maintain oral hygiene and use mouth wash. HIV is now being managed like any other chronic disease like diabetes, etc. There are medications for it to be under control though not a complete cure. So do not worry too much.
Patient's Query
Thank you, doctor, for your reply.
I understand your stance on her possibly not being positive, and this is posing no risk. Would it not be alarming that the symptoms I have been presenting with, especially vertigo with the vomit, still not indicate that I contacted the virus and I have been in the acute stage of infection? I have never had vertigo before, and for this to just randomly show up now, especially after a dirty needle stick, is alarming to me, honestly. I am in a place that is one of the highest-ranking states for the HIV infection rate. The patient is also an advocate for the crack smoker. Other than her test coming back negative, it does not seem like I have a lot going for me symptom wise. Do you believe there will ever be a cure for this disease, or is this wishful thinking?
Hi,
Welcome back to icliniq.com.
Thank you for the follow-up query. The symptoms are nonspecific. They may be due to stress or anxiety or gastritis etc. If it persists, please consult your doctor for examination and management. HIV has multiple drugs that can help in controlling the virus. So it is now almost managed like chronic diseases like diabetes. In the future, good drugs may be further available. Do not worry about all these. Get yourself tested, as mentioned earlier.
Patient's Query
Thank you doctor for your reply.
While I understand stress and anxiety, I have been under stress and anxiety about it. I am not going to deny that. Your a doctor, and I by no means do not want to come off like I am calling you a liar or not because that is not my intention. I have the utmost respect for you and your status. My main concern is how this can even be related to anxiety or stress. From my understanding, stress and anxiety can make symptoms worse, but my understanding of anxiety and stress cannot directly cause lymph node swelling, vertigo, and vomit. Am I wrong? That is why I am concerned. These symptoms line up perfectly for the majority of male patients suffering from the acute HIV infection stage.
Hi,
Welcome back to icliniq.com.
These are nonspecific symptoms and need not be HIV only or suggest HIV. Please read carefully; a lymph node swelling may be due to an infection in the arm or chest area. Other symptoms may be due to anxiety or stress, or gastritis. If this symptom persists, get it evaluated by a physician.
Patient's Query
Thank you doctor.
I appreciate your responses.
One last question. I have read some studies about how antivirals (ART) do not always work for every patient. I am concerned if I contacted this virus that it is a strong possibility that these drugs will not work for me. Is this a true concern? I cannot lie and say that I am not scared when I can die at a young age from this.
Hi,
Welcome back to icliniq.com.
There are many classes of drugs now. The single drug will usually not be given as there are possibilities of developing resistance. So combination drugs are provided, which are more effective. They will change depending on the response, adverse effects, etc. It is almost similar to any other chronic disease now. Do not worry about all these. Just relax and follow tests, as suggested earlier.
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