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Updated June 24, 2006

Case 3: Management of a Needlestick Injury: Source Patient of Unknown Serostatus

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A 32-year-old female medical assistant presents for evaluation immediately after sustaining a needlestick injury. The injury involved a needle used to draw blood on a man whose HIV status is unknown, though he has a known history of injection drug use. Unfortunately, the source patient left the clinic and was not immediately available for further questions or for rapid HIV testing. The involved needle was visibly bloody and stuck the medical assistant in the thumb, through a glove. She denies that the injury was deep. Examination reveals only a pinpoint puncture wound on her thumb. A urine pregnancy test is negative. She has no medical conditions and takes no medications.

Which of the following postexposure prophylaxis (PEP) options is most appropriate for this medical assistant?

A Do not offer PEP because the source patient is not known to be HIV-infected and the mechanism of injury is low-risk for HIV transmission.
B Offer PEP only if testing of the source patient confirms that he is HIV-infected.
C Offer PEP if rapid testing of the needle that caused the injury suggests the presence of HIV.
D Offer PEP with zidovudine plus lamivudine (Combivir) and perform HIV testing on the source patient as soon as it is possible.