{"id":436,"date":"2009-06-13T08:41:16","date_gmt":"2009-06-13T13:41:16","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=436"},"modified":"2015-06-04T15:30:38","modified_gmt":"2015-06-04T19:30:38","slug":"occupational-exposures-and-hiv-testing","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/occupational-exposures-and-hiv-testing\/2009\/06\/13\/","title":{"rendered":"Occupational Exposures and HIV Testing"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2009\/06\/syringes1.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-thumbnail wp-image-437\" title=\"syringes\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2009\/06\/syringes1.jpg\" alt=\"\" width=\"150\" height=\"90\" \/><\/a>A couple of years ago, an ID-colleague of mine told me about a tough case:\u00a0 While working in the ICU, an anesthesiologist sustained a pretty severe needle stick.\u00a0 Approached for HIV testing, the source of the exposure felt threatened by the providers in the ICU, and refused to sign the consent.<\/p>\n<p>The patient then deteriorated and required intubation.\u00a0 The intensivist, understandably in something of a panic, contacted my colleague for advice.<\/p>\n<p>We&#8217;re about to post this case &#8212; actual details of which are slightly changed to protect anonymity &#8212; in <em>AIDS Clinical Care<\/em>. \u00a0 We&#8217;ve asked some experts (MD, lawyer, ethicist) on the matter a few key questions, including:<\/p>\n<ul>\n<li>How would you manage the intensivist who sustained the injury?<\/li>\n<li>Would you give post-exposure prophylaxis? If so, what specifically would you give, and for how long?<\/li>\n<li>How would you determine if the source patient has HIV?\u00a0Would you perform surrogate testing (for example, obtain a CD4-cell count) to assess this?\u00a0Would you consider testing him without written\u00a0informed consent?<\/li>\n<li>If\u00a0he is tested, would you give him the results\u00a0after\u00a0he recovers\u00a0if the test is negative?\u00a0If the test is positive?<\/li>\n<\/ul>\n<p>This case is different from the <a href=\"http:\/\/blogs.nejm.org\/index.php\/2008\/06\/24\/hiv-occupational-post-exposure-prophylaxis-do-the-right-thing\/#more-24\" target=\"_blank\">this one<\/a>, but many of the issues are related.\u00a0 (Different from <a href=\"http:\/\/blogs.nejm.org\/index.php\/2008\/10\/21\/back-to-school-day-4-pep-and-more-pep\/\" target=\"_blank\">this one<\/a> too, obviously.)<\/p>\n<p>And it&#8217;s a reminder that amidst all the controversy over &#8220;opt-out&#8221; testing and HIV screening, there&#8217;s another big issue out there regarding HIV testing that&#8217;s hardly been settled.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A couple of years ago, an ID-colleague of mine told me about a tough case:\u00a0 While working in the ICU, an anesthesiologist sustained a pretty severe needle stick.\u00a0 Approached for HIV testing, the source of the exposure felt threatened by the providers in the ICU, and refused to sign the consent. The patient then deteriorated [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,3,4,5,8,9],"tags":[44,45,163,423,447,504,512,670,742],"class_list":["post-436","post","type-post","status-publish","format-standard","hentry","category-antiretroviral-rounds","category-health-care","category-hiv","category-infectious-diseases","category-patient-care","category-policy","tag-aids","tag-aids-clinical-care","tag-cd4-cell-count","tag-hiv","tag-hiv-testing","tag-informed-consent","tag-intensivist","tag-occupational-exposures","tag-post-exposure-prophylaxis"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/436","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=436"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/436\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=436"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=436"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=436"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}