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blood mixed with lignocaine splash onto eye from hiv+ who is on ART

Question: 

I am recently exposed to a hiv 1 patient during tooth extraction via blood mixed with about 1 ml of lignocaine in a syringe, I felt a resistance during pushing the piston of the syringe. Suddenly the blood mixed lignocaine leaked and splashed to my eyes. I washed my eyes immediately with water and asked the patient about any disease history and he told that he is hiv positive and on ART SINCE last 5 years. I told our chief MO about the incident and he suggested me to Start PEP.. I STARTED PEP within 2 hours TL and LR( tenofovir with lamivudin and lopinavir with ritonavir) and also checked my recent hiv status which came out negative... The ICTC CENTER also informed me that the source patient is on ART his recent cd4 count was nearly 560 and pt is well controlled.. My last information is I washed the syringe to remove the major blood from the transparent portion with water before drawing 2nd time lignocaine.and the retained blood from needle and hub was then mixed with 1 ml of lignocane... how much risk in this situation ? please enlighten me... i am from India

Answer: 

Hello,

Thank you for your inquiry. From what we gather from the question, you were asking about the risk of acquiring HIV from blood mixed with lignocaine that splashed into your eyes while performing a tooth extraction on a person living with controlled HIV. From the information given, this scenario is determined to be Low Risk (evidence of transmission occurs through these activities when certain conditions are met).

The scenario mentioned above could meet the three components of the Transmission Equation if the blood that splashed into your eyes contained the HIV virus and was able to gain access to your bloodstream through the mucous membrane. It is important to note that transmission is very unlikely in this scenario since the patient likely has a very low HIV viral load in their blood due to their use of antiretroviral therapy (ART) for the past 5 years. According to the Centers for Disease Control and Prevention, the likelihood of acquiring HIV if blood containing the HIV virus is splashed in the eye, nose, or mouth are about 1 out of 1,000 (1). These odds demonstrate that even if there is HIV present in the blood that splashed into your eyes, it is very unlikely to cause transmission. Your odds of acquiring HIV after this occupational expsoure are also further reduced since you accessed post-exposure prophylaxis (PEP) within the recommended 72 hours post-exposure (2). Due to the known status of the blood that splashed into your eye, it is recommended to access an HIV test outside of the window period.

Recommendation: Refer to a physician for an HIV test outside of the window period post-PEP.

Regards,

AIDS Vancouver Helpline/Online, Marie