Needle stick injuries

Question 1

What are risk factors for HIV transmission in a needle stick injury?

Answer 1

• source considered likely to have HIV
• incident involved needle syringe with visible blood
• blood may have been injected

Question 2

How to prevent needle stick injuries

Answer 2

• educate about problem of discarded needles
• provide age-appropriate education on dangers of IDU to children and youth
  
  • teach not to touch/handle needles & syringes - report finding them to responsible adult who can do safe disposal
• community programs to keep areas free of discarded needles
• programming for treatment and control of injection drug addiction, support HIV prevention, HBV vaccination, needle exchange programs

Question 3

Blood sample on children after needle stick injuries?

Answer 3

• HBV, HIV, HCV status (baseline)
• if starting ART: CBC, AST, ALT, ALP, BUN, Cr
• Testing needle & syringe for viruses not indicated
• if user of needle known - test for viruses on the user

Question 4

Hepatitis B virus prophylaxis with needle stick injury?

Answer 4

Child not fully vacciniated: do HBsAg and anti-HBsAg

• anti-HBsAg and HBsAg negative: HBV & HBIG
• anti HBsAg positive: complete vaccine series
• HBsAg positive: stop vaccines, follow up

Child fully vaccinated: do ant-HBsAg

• anti-HBsAg negative: do HBsAg

Follow up

• 4 wk: give second HBV vaccine if only one previous received
• 6 mo: anti-HBsAg antibody, HBV 3rd dose if 2 previous doses received
• If anti-HBsAg negative at 6 mo; test 1-2 mo after 3rd dose of vaccine.
  
  • If still negative, test for HBsAg. If both negative, give 4th dose HBV and test again 1-2 mo later. If still negative, refer to specialist

Question 5

HIV prophylaxis with needle stick injury?

Answer 5

• recommend ART proph only in cases of high risk (source considered likely to have HIV, incident involved needle and syringe with visible blood, blood may have been injected)
• discuss but don’t recommend proph in low risk situations
  
  • reassure that chance of transmission extremely low
• If starting ART:
  • start ARV within 1-4 hours; no later than 72 hours
  • Prophylaxis: 28 days
• ART recommendations
  
  • young children: zidovudine, lamivudine, lopinavir/ritonavir
  • => 12 yr (and wt >35kg): emtricitabine + tenofovir + raltegravir or dolutegravir (better tolerated)
  • if alternatives needed, consult specialist
  • tenofovir contraindicated if poor renal function
• Follow up
  
  • R/A at 2-3 days (phone or visit)
  • FU at 2 and 4 weeks for adherence asssessment, drug tolerance, CBC, AST, ALT, Cr
  • 4-6 wk: test anti-HIV antibody
  • 3 mo: test anti-HIV antibody (unless previously positive) and anti-HCV antibody
  • 6 mo: test anti-HIV, anti-HCV, anti-HBsAg antibody (unless prev positive)
    
    • can omit HIV test if 3 mo test used fourth generation combo HIV p24 antigen-HIV antibody test and no HCV (HCV delays HIV seroconversion)

Question 6

Which ART cannot be given if there is poor renal function?

Answer 6

tenofovir

Question 7

What co-infection causes delayed HIV seroconversion?

Answer 7

HCV

Question 8

What is the follow up schedule post needle stick injury?

Answer 8

• [only if on ART] 2-3 days: (R/A ART via phone or visit)
• [only if on ART] 2 and 4 weeks: ART adherence assessment drug tolerance, CBC, AST, ALT, Cr
• 4 wk: give second HBV vaccine if only one previous received
• 4-6 wk: test anti-HIV antibody
• 3 mo: test anti-HIV antibody (unless previously positive) and anti-HCV antibody
• 6 mo: test anti-HIV, anti-HCV, anti-HBsAg antibody (unless prev positive)
  
  • can omit HIV test if 3 mo test used fourth generation combo HIV p24 antigen-HIV antibody test and no HCV (HCV delays HIV seroconversion)
  • HBV 3rd dose if 2 previous doses received
• If anti-HBsAg negative at 6 mo; test 1-2 mo after 3rd dose of vaccine.
  
  • If sitll negative, test for HBsAg. If both negative, give 4th dose HBV and test again 1-2 mo later. If still negative, refer to specialist