infectivity of HIV
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Etiology
Viral syndromes associated with HIV infection (cofactors):
- Herpes simplex
- Herpes zoster (shingles)
- oral hairy leukoplakia (Epstein-Barr virus)
- Molluscum contagiosum
Epidemiology
- rare cases of female to female transmission reported[6]
Pathology
Infectivity:*
- HIV may be found in all body fluids, tissues that may transmit HIV include:[2]
- blood
- semen
- vaginal secretions
- CSF
- synovial fluid
- pleural fluid
- pericardial fluid
- peritoneal fluid
- amniotic fluid
- breast milk
- saliva[2] no evidence that HIV is transmitted through saliva[3]
- any unfixed tissue or organ
- routes of transmission
- sexual transmission: anal, oral, vaginal intercourse
- men transmit infection to women more readily than visa versa
- high risk of transmission with receptive anal intercourse
- blood or blood products
- percutaneous inoculation
- injection drug use
- contaminated needle stick
- 0.3% risk of HIV transmission/exposure
- mucocutaneous exposure
- 0.09% risk of HIV transmission/exposure
- perinatal transmission: in utero, at delivery, breast feeding
- sexual transmission: anal, oral, vaginal intercourse
- epithelial trauma is important in transmission
- latex condoms provide protection
- douching does NOT provide protection
- depo-Provera use among women seems to increase risk of HIV1[7]
- 90-99% of the HIV virus will die within several hours outside a human host
- antiretroviral therapy at the time of exposure decreases infectivity of an inoculum (as much as 80%)
- zidovudine 200 mg TID for 4 weeks plus a 2nd agent such as lamvudine
- if the source patient has been treated with zidovudine (possible resistance), add a protease inhibitor
- prophylaxis must be given within 1-3 hours
- 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
- antiretroviral therapy lowers risk of HIV transmission by 92% among serodiscordant heterosexual couples[4][5]
- reducing HIV1 RNA viral load to undetectable eliminates risk of transmission during sex[8]
- risk for HIV1 transmission per single exposure
- occupational - needle stick (0.3%)
- occupational exposure - mucous membrane (0.09%)
- needle sharing injection drug use (0.7%)
- receptive anal intercourse (0.5%)
- receptive vaginal intercourse (0.1%)
- insertive anal intercourse (0.07%)
- insertive vaginal intercourse (0.05%)
- oral sex (0.01%)[1]
* also see OSHA standards
More general terms
Additional terms
- complications in patients with HIV1 infection
- Occupational Safety Health Act of 1970 (OSHA)
- perinatal transmission of HIV
- safe sex (prevention of HIV1 & other STDs)
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. 18, 19. American College of Physicians, Philadelphia 1998, 2017, 2018, 2022.
- ↑ 2.0 2.1 2.2 Veterans Administration, Mather, CA
- ↑ 3.0 3.1 Stevens LM et al, HIV Infection: The Basics, JAMA Patient Page JAMA 2008, 300(5):614
- ↑ 4.0 4.1 Donnell D et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: A prospective cohort analysis. Lancet 2010 Jun 12; 375:2092. PMID: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/20472675 - ↑ 5.0 5.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23206835 <Internet> 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23206834 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962005-4/fulltext - ↑ 6.0 6.1 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
- ↑ 7.0 7.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25578825 <Internet> http://www.thelancet.com/journals/lancetid/article/PIIS1473-3099%2814%2971052-7/abstract
- ↑ 8.0 8.1 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: https://www.ncbi.nlm.nih.gov/pubmed/27404185
Daar ES, Corado K. Condomless sex with virologically suppressed HIV-infected individuals: How safe is it? JAMA 2016 Jul 12; 316:149. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27404181