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HIV exposure/transmission

Cordula wrote--

"Hello Ron, 
this time in your calculations you forget that not every time someone 
has unprotected intercourse, STIs or HIV get transmitted, even if one 
of the partners is infected. It still needs STATISTICALLY several 
hundred unprotected intercourses to transmit HIV," 

Cordula Schuemer

I respond--

As a State employee trained in universal precautions, and as an em-
ployee placed in situations where there were unexpected conditions 
that could result in exposure to body fluids infected with HIV/HCV/ 
HBV, every exposure is required to be considered an actual exposure. 
The site population is 35% HIV/HCV positive. Anyone whose body was 
exposed to another's body fluids was to be treated according to the 
procedures described below, with anti HIV treatment beginning within 
a few hours at the nearest emergency room. There are many documented 
cases of medical staff contracting HIV/HCV by one contact with in-
fected body fluids through a break in the skin, a needle prick, or by 
the eyes or up the nose (when sprayed with body fluids). 

There is no State Health official who would agree with your state-
ment, "It still needs STATISTICALLY several hundred unprotected 
intercourses to transmit HIV". None of the following agree with that 
"Healthcare personnel should assume that the blood and other body 
fluids from all patients are potentially infectious. They should 
therefore follow infection control precautions at all times." "These 
precautions include: 

* the routine use of barriers (such as gloves and/or goggles) when
  anticipating contact with blood or body fluids 
* washing hands and other skin surfaces immediately after contact
  with blood or body fluids, and 
* the careful handling and disposing of sharp instruments during and
  after use." 

"Safety devices have been developed to help prevent needle-stick in-
juries. If used properly, these types of devices may reduce the risk 
of exposure to HIV. Many percutaneous injuries are related to sharps 
disposal. Strategies for safer disposal, including safer design of 
disposal containers and placement of containers, are being devel-

"Although the most important strategy for reducing the risk of occu-
pational HIV transmission is to prevent occupational exposures, plans 
for post-exposure management of health care personnel should be in 
place. CDC has issued guidelines for the management of HCP exposures 
to HIV and recommendations for post-exposure prophylaxis (PEP): Up-
dated U.S. Public Health Service Guidelines for the Management of Oc-
cupational Exposures to HBV, HCV, and HIV and Recommendations for 
Post-exposure Prophylaxis (June 29, 2001)." 

"These guidelines outline a number of considerations in determining 
whether or not healthcare personnel should receive PEP and in choos-
ing the type of PEP regimen. For most HIV exposures that warrant PEP, 
a basic 4-week, two-drug (there are several options) regimen is rec-
ommended. For HIV exposures that pose an increased risk of transmis-
sion (based on the infection status of the source and the type of ex-
posure), a three-drug regimen may be recommended. Special circum-
stances such as a delayed exposure report, unknown source person, 
pregnancy in the exposed person, resistance of the source virus to 
antiviral agents, and toxicity of PEP regimens are also discussed in 
the guidelines. Occupational exposures should be considered urgent 
medical concerns." 


Please see the following: CDC-NCHSTP-Division of HIV/AIDS Prevention 
- Fact Sheet - Preventing Occupational HIV Transmission to Health 
Care Worker - National Center for HIV, STD and TB Prevention Divi-
sions of HIV/AIDS Prevention Fact Sheets | Home | Index | Search | 
Site Map | Subscribe Preventing Occupational HIV Transmission to 
Healthcare Personnel As of June 2001, occupational exposure to HIV

* Transmission and Prevention of HIV - > Home > Knowledge Base > 
Transmission & Prevention Transmission and Prevention of HIV Concepts 
and Techniques of HIV Prevention Effective Behavioral Interventions 
Voluntary Counseling and Testing The Effect of Antiretroviral Therapy 
on Transmission.

* Transmission: Sexual Exposure Is A Major Means Of HIV Spread Among 
Injection Drug Users In San Francisco, May 21-28, 200 - 
Headline News page, daily women's health news.

* WebMD/Lycos - Article - Preventing Occupational HIV Transmission to 
Health Care Workers - With Lycos, WebMD offers a comprehensive online 
health resource. Whether you want to get information about a medical 
condition, learn more about leading a healthier lifestyle, or talk to 
others with similar health concerns, WebMD is the place to go.

* Prevent Transmission of HIV and Hep. B Virus to Patients - Recom-
mendations for Preventing Transmission of Human Immunodeficiency Vi-
rus and Hepatitis B Virus to Patients During Exposure-Prone Invasive 

Occupational Exposure to HIV: Overview - Occupational Exposure to HIV 
Overview: Approximately 4.4 million health care workers in the United 
States receive an estimated 800,000 needle sticks and other injuries 
from sharp objects annually.[1] "An estimated 16,000 of these objects 
are contaminated with HIV.[2]" "HIV is transmitted by approximately 3 
of every 1000 HIV-contaminated needle sticks.[3]"

"In spite of the widespread acceptance of universal precautions as 
required by the Occupational Safety and Health Administration (OSHA), 
the overall rate of needle-stick injuries remains high.[2] The risk 
of HIV transmission was decreased by 79% in healthcare workers who 
received zidovudine after their exposure.[4]"

"Since HIV transmission was reduced by approximately 79% when health 
care workers with percutaneous exposure to HIV-infected blood re-
ceived zidovudine,[4] in June 1996 the Public Health Service issued 
provisional recommendations for chemoprophylaxis after exposure, de-
pending on the type of exposure and the source. After a percutaneous 
exposure to blood, treatment with zidovudine plus lamivudine is rec-
ommended for four weeks. For workers whose exposures place them at 
the highest risk, treatment with indinavir, a protease inhibitor, 
should be added.5"

"In the case of HIV, prophylaxis should be initiated promptly, pref-
erably within one to two hours after the exposure.[5] Follow-up coun-
seling and medical evaluation as summarized in the Public Health Ser-
vice recommendations is a necessity.5"

"Some health-care workers have become infected with HIV by being 
stuck with needles containing HIV-infected blood. Even fewer have be-
come infected by HIV-infected blood getting into the health-care 
worker's bloodstream through an open cut or splashes into a mucous 
membrane (e.g. eyes or the inside of the nose)." "Oral sex with an 
infected partner does carry some risk of infection. If a person sucks 
on the penis of an infected man, for example, infected fluid could 
get into the mouth. The virus could then get into the blood if you 
have bleeding gums or tiny sores somewhere in the mouth."

Ron Tyler

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