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infectivity of HIV

Etiology: Viral syndromes associated with HIV infection (cofactors): 1) Herpes simplex 2) Herpes zoster (shingles) 3) oral hairy leukoplakia (Epstein-Barr virus) 4) Molluscum contagiosum Epidemiology: - rare cases of female to female transmission reported [6] Pathology: Infectivity:* 1) HIV may be found in all body fluids, tissues that may transmit HIV include: [2] a) blood b) semen c) vaginal secretions d) CSF e) synovial fluid f) pleural fluid g) pericardial fluid h) peritoneal fluid i) amniotic fluid j) breast milk k) saliva [2] no evidence that HIV is transmitted through saliva [3] l) any unfixed tissue or organ 2) routes of transmission a) sexual transmission: anal, oral, vaginal intercourse 1] men transmit infection to women more readily than visa versa 2] high risk of transmission with receptive anal intercourse b) blood or blood products c) percutaneous inoculation 1] injection drug use 2] contaminated needle stick - 0.3% risk of HIV transmission/exposure d) mucocutaneous exposure - 0.09% risk of HIV transmission/exposure e) perinatal transmission: in utero, at delivery, breast feeding 3) epithelial trauma is important in transmission 4) latex condoms provide protection 5) douching does NOT provide protection 6) depo-Provera use among women seems to increase risk of HIV1 [7] 7) 90-99% of the HIV virus will die within several hours outside a human host 8) antiretroviral therapy at the time of exposure decreases infectivity of an inoculum (as much as 80%) a) zidovudine 200 mg TID for 4 weeks plus a 2nd agent such as lamvudine b) if the source patient has been treated with zidovudine (possible resistance), add a protease inhibitor c) prophylaxis must be given within 1-3 hours 9) HIV-infected health care workers, including physicians, surgeons & dentists must follow standard universal precautions & not engage in clinical work if they have anopen skin lesion 10) antiretroviral therapy lowers risk of HIV transmission by 92% among serodiscordant heterosexual couples [4,5] 11) reducing HIV1 RNA viral load to undetectable eliminates risk of transmission during sex [8] 12) risk for HIV1 transmission per single exposure a) occupational - needle stick (0.3%) b) occupational exposure - mucous membrane (0.09%) c) needle sharing injection drug use (0.7%) d) receptive anal intercourse (0.5%) e) receptive vaginal intercourse (0.1%) f) insertive anal intercourse (0.07%) g) insertive vaginal intercourse (0.05%) h) oral sex (0.01%) [1] * also see OSHA standards

Related

complications in patients with HIV1 infection Occupational Safety Health Act of 1970 (OSHA) perinatal transmission of HIV safe sex (prevention of HIV1 & other STDs)

General

infection control

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. 18, 19. American College of Physicians, Philadelphia 1998, 2017, 2018, 2022.
  2. Veterans Administration, Mather, CA
  3. Stevens LM et al, HIV Infection: The Basics, JAMA Patient Page JAMA 2008, 300(5):614
  4. Donnell D et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: A prospective cohort analysis. Lancet 2010 Jun 12; 375:2092. PMID: 20537376 - Del Romero J et al. Combined antiretroviral treatment and heterosexual transmission of HIV-1: Cross sectional and prospective cohort study. BMJ 2010 May 14; 340:c2205 PMID: 20472675
  5. Jia Z et al Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003--11): a national observational cohort study The Lancet, Early Online Publication, 1 December 2012 PMID: 23206835 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961898-4/fulltext - Vermund SH Treatment as prevention for HIV in China. The Lancet, Early Online Publication, 1 December 2012 PMID: 23206834 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962005-4/fulltext
  6. Chan SK et al Centers for Disease Control and Prevention (CDC) Likely Female-to-Female Sexual Transmission of HIV - Texas, 2101 MMWR Weekly. March 14, 2014 / 63(10);209-212 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6310a1.htm
  7. Ralph LJ et al Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies. The Lancet Infectious Diseases. Online: Jan 2015 PMID: 25578825 http://www.thelancet.com/journals/lancetid/article/PIIS1473-3099%2814%2971052-7/abstract
  8. Rodger AJ et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA 2016 Jul 12; 316:171. PMID: 27404185 - Daar ES, Corado K. Condomless sex with virologically suppressed HIV-infected individuals: How safe is it? JAMA 2016 Jul 12; 316:149. PMID: 27404181