What testing is indicated in the potential source of an occupational HIV exposure?

Updated: Jul 27, 2020
  • Author: Ana Elizabeth Markelz, MD, FACP, FIDSA; Chief Editor: John Bartlett, MD  more...
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Answer

The source person may know his or her HIV status, and the person’s health records may be readily available. If the source person’s HIV status is unknown, voluntary testing for HIV (preferably the fourth-generation test), HCV Ab, and HBsAg should be performed. If these tests have previously been performed, clinical judgment should be used to determine whether the studies need repeating. Rapid EIA HIV Ab testing is extremely sensitive and specific and, if positive, should be considered a true positive for the purposes of PEP decision-making. A positive rapid test result requires a confirmatory HIV 1/2 Ab differentiation immunoassay. If the rapid HIV test is not available on a timely basis, PEP treatment should be started knowing that it can be stopped if the test yields a negative result.

If the source patient has known HIV infection, relevant information regarding most recent viral load, antiretroviral therapy (ART) history, and the most recent resistance test results should be elicited. If the HIV status of the source in unknown, HIV testing, preferably with the fourth-generation HIV test, as advocated by the CDC, should be performed. This test may return false-negative results during the first 2 weeks of virus transmission. Note that there have been no reported cases of transmission involving an exposure, during this period, although this is a time in which the viral load is especially high, suggesting very high vulnerability. [8] If the source person has been at risk for HIV exposure during the preceding 2 weeks, HIV viral load testing should be considered. Permission for testing should be obtained from the source person. Refusal by the source person for blood draw should be discussed with the local health department for assistance in the matter. Laws and regulations regarding this scenario vary from state to state.


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