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Infant had a blood contamination incident. Why is she falling sick? Does nasonex cause wrong HIV antibody test?

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Dr,
My 3 year old had a blood contamination incident and that is the reason i am very much worried is that she is falling sick all the time. It was a very unfortunate and a risky blood contamination incident in the genetic clinic.



After that incident she is continously falling sick once or twice very month with runny nose, cold, cough and sometimes fever. It has been close to one year now and we are dealing with the same situation day in and day out. Before the incident i rarely remember taking her to the doctor once every 6 month.

After three days after the day of the blood contamination incident, she had high running nose, cough, and after seven days after the blood was drawn, she has high fever from the past four days including the running nose and cough, and is taking ibuprofen to control the temperature, and an antibiotic as well.

She uses Albuterol, budesonide(oral inhalers) in her nebulizer and some antiboitics(if she has fever), she takes Nasonex shots, and she uses Waldryl allergy and Zyrtec.

My pediatrician because of the blood contamination incident, got her tested for Hep A, Hep B, Hep C and HIV after 5 months 20 days after the incident.

Now she is 4 years old.


My question to you doctor is do you think using these medications either budesonide or those antibiotics or those Nasonex shots or Waldryl,Zyrtec.

Do these medications or treatments cause a wrong HIV antibody test result or a delay. Would that in any way affect my test results/ antibody production?

They did a western blot for HIV without doing an elisa, it was negative.

1) Does budesonide have any effect on her Hepatitis A,B,C antibody test or her HIV antibody test result by delaying or hiding the antibodies?
2) The HIV antibody test(Western Blot) and the Hep A, Hep B, Hep C antibody test was done 5 months 20 days after the exposure. Is that enough window period considering she is a 3 and half year old. or do kids have longer window periods. I see everywhere for adults the window period is 3 months, and am not sure about the 3 year kid.
3) Does any antibiotics(i don't remember which antibiotics she used) have any effect on her HIV antibody test result or her Hep A, Hep B, Hep C antibody test results by delaying or hiding the antibodies.
4) Does any of her immunizations have any effect on the HIV antibody or Hep A, Hep B, Hep C test result?. She got her 3 year immunizations five months before the HIV antibody test.
5) Does her Nasonex(steroid) or waldryl alergy or zyrtec/singular have any effect on her HIV antibody test result or the Hep A, Hep B, Hep C antibody test result?
Posted Thu, 7 Jun 2012 in HIV and AIDS
 
 
Answered by Dr. Sudarshan 18 hours later
Hi,
Thanks for writing in.
I can understand your anxiety and will try to answer your queries.
1) Does budesonide have any effect on her Hepatitis A,B,C antibody test or her HIV antibody test result by delaying or hiding the antibodies?
Budesonide is a corticosteroid which suppresses immune system and antibody production . As your daughter has undergone Western blot test for HIV which is not affected by steroids, its almost impossible that she is infected.

2) The HIV antibody test(Western Blot) and the Hep A, Hep B, Hep C antibody test was done 5 months 20 days after the exposure. Is that enough window period considering she is a 3 and half year old. or do kids have longer window periods. I see everywhere for adults the window period is 3 months, and am not sure about the 3 year kid.
Window period for children above 18 months of age is same that of adults which is 3 months. In your daughter’s case, as the test was done after 5 months and she tested negative, you can be rest assured that the results are confirmatory . So you need not worry.




3) Does any antibiotics(i don't remember which antibiotics she used) have any effect on her HIV antibody test result or her Hep A, Hep B, Hep C antibody test results by delaying or hiding the antibodies.

Antibiotics have no effect on the formation of antibodies which are detected by these tests.

4) Does any of her immunizations have any effect on the HIV antibody or Hep A, Hep B, Hep C test result?. She got her 3 year immunizations five months before the HIV antibody test.

Immunization can cause false positive test results (positive report in absence of
infection) but will not cause a negative test in presence of infection.

5) Does her Nasonex(steroid) or waldryl alergy or zyrtec/singular have any effect on her HIV antibody test result or the Hep A, Hep B, Hep C antibody test result?

-As we have discussed, steroids can suppress the antibody production and cause negative results but it is highly unlikely with inhaled steroids and can occur if person is on high dose oral steroids.



To summarize the whole thing I believe that your daughter does not have any of the infection tested neither hepatitis nor HIV.
Regarding the recurrent infections she is having, they may be due to long term steroid intake which weakens the immune system of body.

I would suggest that you get her off the steroid by substituting it with some other medication after consultation with immunologist.

If you need any further clarification do let me know.

Regards
Dr Sudarshan
Above answer was peer-reviewed by
 
Follow-up: Infant had a blood contamination incident. Why is she falling sick? Does nasonex cause wrong HIV antibody test? 27 minutes later
Thank you for your expertise and your advice Dr. XXXXXXX

I understand what you are saying about the inhaled steroids.

So can i believe the accuracy of the HIV antibody test and the Hepatitis antibody test result? I thought that western blot test also looks for antibodies and so any steroids might cause false negative result?

Should i go for any PCR or any other tests to be absolutely certain?




 
 
Answered by Dr. Sudarshan 18 minutes later
Hi,
Thanks for writing back.
Western blot test for HIV is highly specific and confirmatory test. The usual sequence is to do ELISA for HIV first and then Western blot for confirmation. I dont think you need to do a PCR test for her.

A negative HIV western blot rules out the infection.

Try to get her off steroids with the help of your doctor or at least taper the dose. Provide her with good nutritious diet with lots of fruits and XXXXXXX leafy vegetables. She needs a lot of good quality proteins from eggs and dairy products to help build her immunity. Overall, she needs to be healthy to fight off common infections.


Hope this helps.

Dr Sudarshan
Above answer was peer-reviewed by
 
Follow-up: Infant had a blood contamination incident. Why is she falling sick? Does nasonex cause wrong HIV antibody test? 19 hours later
Thanks for your answer and your time Dr. XXXXXXX It means so much to me.

My pediatrician tested for all these HIV and Hep A,Hep B and Hep C two times, once at 6 weeks after the incident and once at 5 month, 20 days after the incident. At 6 weeks he requested an Elisa for HIV and at 5 month 20 days he requested a Western Blot for HIV.

Before the 5 months 20 days testing Dr, i think we did not use budesonide regularly. We used to use Albuterol and benadryl. We might have used Budesonide 30 times in that 5 months 20days if i were to take a guess. and Nasonex may be 20 times in that whole 5 months 20days again guessing.

a) So with these amount of usage of budasonide and Nasonex, do i still need to worry about the accuracy of the HIV antibody test and the Hepatitis antibody test?

b) Or do you recommend me taking her off the budasonide and nasonex and working on a healthy diet and later after three months or so, then get an antibody test just to be certain? Do you think that three months after stopping these medications, and then getting one more antibody test, will that be enough time to give a result for sure.
I am sorry i am very much worried. Or do i just need to forget about it and move on.




But after the 5 months 20 days test, we are using it very regularly probably every day.

We have spoken to our pediatrician expressing our concerns, that i am not sure if it is a mere coincidence that after the incident she is getting this cold and cough so often. My pediatrician says that she has allergies, and most of the kids get these cold and cough at a certain age and grow out of it, after a year or so.
 
 
Answered by Dr. Sudarshan 5 hours later
Hi again dear,
Thanks for details.
I tend to agree with your paediatrician.

The children are not primed to the weather changes and allergens of the surrounding.

That is the reason for allergies and recurrent cold in your child.
As the children grow up tolerance of immune system increases and these episodes reduce.

It has nothing to do with HIV and Hepatitis as it is evident by your negative tests at 2 occasions.

The test are highly accurate and you should get the fear of these blood borne diseases out of your mind and move on .Do not subject your child to any further tests.

Hope I’ve made myself very clear.
If you need any further clarification do let me know.

If you are satisfied my answers please indicate it by rating my answer at the end.

Regards
Dr Sudarshan
Above answer was peer-reviewed by
 
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