Dear Lisa,

Unfortunately, there is no cut and dried answer to this - it is one of those risk vs. benefit situations.  Personally, I think that the risk of formula would far outweigh the risk of contracting HIV in most situations.  When there is a needlestick, the employee has their blood drawn for testing.  Sometimes, testing is also done on the patient, but not always and sometimes you don't know who the patient was - here is where part of the risk assessment comes in.  If the patient tests negative at the time of injury and is also in a low risk category for the disease, I would say that the risk is exceedingly low.  If the needlestick involved the blood of a 92 year old, I would say the risk of HIV infection would also be extremely low.  If it involved the blood of the average middle class citizen, the risk would also be quite low, but not as low as the very old patient.  If it was the blood from a known drug addict, the risk factor begins to increase.  If it was the blood from someone known to be HIV positive, the risk increases again (but it is still not that great).  If you are poked with a needle put in the trash by mistake, you may not have any idea where it came from, but I would say overall the risk was pretty low, depending on the location of the trash in question.  When an employee gets a needle stick, they have the option of starting treatment immediately, which some people do if the stick was from an HIV positive patient or someone else in a high risk category.  Immediate treatment would most probably prevent or greatly reduce the possibility of HIV in the milk.  And then you have to consider new research that shows that HIV infection may not be much of an issue if the baby is EXCLUSIVELY breastfed.

The employee will again have blood drawn at 3 months and 6 months post-exposure.  How will the mom feel if she weans the baby and then discovers that she has remained HIV negative?  I have worked in the lab for many years and everyone gets a needlestick injury from time to time. Nobody that I know has ever contracted anything from a stick, although it does happen (don't know the present statistics).  This is something that the mom needs to sit down and think very carefully about before making a decision, the consequences of which will affect her and her baby forever, one way or the other.

Consider this.  The mom gets stuck, weans the baby and a few years later the child dies from one of the types of cancer known to occur more frequently in babies who were fed formula.  How will she feel then?  I think that the possibility of the baby suffering adverse health affects from consuming formula is much greater than the possibility of the baby contracting HIV from her milk after a stick.

There is rarely black and white in this world.  One of the unending tasks of life is using our grey matter to wade through all the grey areas that permeate most of our existence.




Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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