Denise,
Has this mom, who is a surgical resident, looked at the CDC website?  If not,
she might be interested in reading this pdf file.
http://www.cdc.gov/mmwr/PDF/rr/rr5011.pdf

According to the CDC, the average risk of HIV transmission after a
percutaneous exposure to HIV infected blood is estimated to be approximately 0.3% (95%
confidence interval).  As of  June 2000 (since 1981) the CDC has documentation
of "56 US health care providers with HIV seroconversion temporally associated
with an occupational HIV exposure."  For an "infectious" agent, this sure is
an amazing statistic.

This CDC site states that "the HCP (health care provider) must strive to
balance the risk of infection against the potential toxicty of the agents used
when seleting a drug regimen."  The toxicity of these various drugs is long and
very scary.  According to the CDC pdf file nearly 50% of health care workers
experience adverse symptoms.
Toleration of these drugs can be very difficult for many people, some of
these drugs can cause life threatening problems.  The CDC lists them in a chart at
this website. Health care workers should not take nevirpine (viramune)
because it can produce liver damage severe enough to necessitate liver
transplantation. This can happen within a short time--one health care worker had liver
failure within 2 weeks.  And to think this drug is an acceptable drug for infants
to prevent MTCT of HIV. The recommendation for exposed health care workers is
to take these antiretrovirals for 4 weeks, if tolerated.

I believe that it might be worthwhile to recommend counseling for this mom.
Losing the breastfeeding relationship is hard to bare, as well as having to
deal with the enormous physical and mental stress of this accidental exposure.
I think suggesting the use of banked human milk is excellent since the mother
seems adverse to relactating when she is through with her meds. With the kind
of meds this mom will be on, it maybe impossible for her to feel good enough
to work with pumping and pasterization of her milk.  You state in your post
that the mom was not planning on pumping or using a lactaid.  So it would seem
that this mom has already decided what she is willing and able to do.  There
isn't much information about post-exposure-occupational exposure and
breastfeeding because there aren't many HCP that are exposed (56 known to the CDC from
1981-2000).  So looking for studies maybe like looking for a needle in a
haystack.
Valerie W. McClain, IBCLC

PS:  The Florida proposed mandatory HIV testing of infant newborns is
currently in the appropriation subcommittee on Health and Human Services with the
chair being Durell Peaden Jr.  This proposed mandatory law will impact informed
consent.  It certainly does not create good patient/health care provider
relationships.  After the NY State law went into effect, physicians found a high
rate of false-positives leading to unnecessary antiretroviral therapy for infants
and mothers.  They identified 32 HIV-positive women, after retesting 17 were
determined to be be hiv negative, 13 of the 17 babies were started on
antiretroviral therapy.  see:
http://www.ama-assn.org/amednews/2000/03/13/hlsa0313.htm
Any Florida people on this list please write your state representatives
(email me if you need to know who to write to)!  According to a Philadelphia
attorney, David W. Webber, Florida's current law(as well as New Jersey's) on HIV
testing is potentially highly coercive and implicitly places the health care
provider in an adversarial relationsip to the patient.  The current law in place
is questionable but mandatory testing seems to be a step backwards,
particularly when rates of transmission between mother and child are heading downwards.
(out of 205,580 live births in Florida, 37 were HIV positive in 2002).
Antibody testing in low prevalence areas creates alot of false-positives.

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