Q: If a person is exposed to potential bloodborne pathogens (e.g., inadvertently given another patient’s dialysate for hemodialysis), when is the best time to recheck for possible development of disease, such as HIV or hepatitis?
—Jan Mailloux, PA-C, Mineral Point, Wis.
A: After obtaining informed consent, test the source individual’s blood as soon as possible for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), and HIV. If the source is already known to be infected, testing is not necessary. Testing of the exposed person depends on the results of the source patient’s tests. Based on the CDC recommendations for health-care professionals who are exposed, the following seems prudent:
Hepatitis B virus (HBV)—Review vaccination status of exposed person. Check immune status by testing for hepatitis B surface antibody. If the exposed person is not immune, hepatitis B vaccine should be administered as soon as possible (within 24 hours). If the source patient is HBsAg-positive, hepatitis B immune globulin should also be administered within 24 hours. If the exposed person had an adequate antibody response (>10 mIU/mL) documented after completion of an HBV vaccination series, no further testing is necessary.
Hepatitis C virus (HCV) —Persons exposed to an HCV-positive source should have the following: Baseline testing for anti-HCV, HCV RNA and alanine aminotransferase (ALT); follow-up testing for HCV RNA four to six weeks after exposure; follow-up testing for anti-HCV RNA and ALT four to six months after exposure.
HIV—If the source individual is seronegative for HIV, baseline testing or further follow-up of the exposed person is usually not necessary. If there is uncertainty or if the source is HIV-positive, HIV-antibody testing should be done at baseline and performed for at least six months post exposure (typically at six weeks, 12 weeks, and six months). Extended HIV follow-up for 12 months is recommended in certain situations. For more information, refer to MMWR Recomm Rep. 2005;54:220-223.
— Jo Ann Deasy, PA-C, MPH