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Master Class: HIV Transmission

2 July 2009 6 Comments

Several factors are important in determining if the HIV virus can be passed from an infected person to another person. These include biological and social factors and they relate to both the exposed and the “infector” individuals.

This conceptual framework summarises only the biological factors that influence HIV transmission. When assessing the risk of infection, each of them should be considered in turn and as a whole.

Conditions Affecting HIV Transmission v2

Exposure alone is not enough to predict a risk of infection, viral load maters and though there is no direct correlation between viral load and infectiousness, a high viral load has been associated with higher infectiousness. However, a low viral load may not be underrated if exposure is direct through blood, like with IDUs.

When it comes to sex with an HIV-infected person or a person of unknown status, different levels of risk have been attributed to different sexual practices. But this does not mean that the risk is always the same for the same practice. Oral sex may be overall much safer than unprotected anal sex, but oral sex with bleeding teeth and rotten gum isn’t certainly safe!

By and large, there is no clear cut or definitive risk factor and often risk is what we estimate it to be and how we relativise it. The risk of HIV infection is dynamic and depends on many factors who weight differently in the scale. Though there is an agreement that some factors weight more than other this cartoon does not give a weight to each factor identified as this is open to debate and only add to the existing confusion around risk.

Knowing and understanding what these factors are and how they interact one with another to determine the overall level of risk of HIV infection when exposed to the virus, particularly during sexual intercourse, will help individual to assess the risk of being infected.

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6 Comments »

  • [him] Moderator said:

    What do tattoos have to do with it? There has never been a case report of tattooing causing HIV transmission …

    # 4 July 2009 at 12:11 pm
  • [him] Moderator said:

    Although the link is broken it probably points to one study that shows and association between being in jail, getting a tattoo, and HIV seropositivity. Association is not causation. Over thirty million people have been infected through unprotected sex, use of nonsterile injecting equipment, and being born to seropositive mothers. Is there a single case report of one person being infected through receiving a tattoo? No. It is time to put this myth to rest.

    [him] moderator
    http://him.civiblog.org

    # 5 July 2009 at 12:34 am
  • peripheries said:

    Anything that potentially allows another person's blood to get into your bloodstream carries a risk. If instruments contaminated with blood are not sterilised between clients then there is a risk of HIV transmission. This is particularly relevant in setting where the practionner is not a professional and conditions of work are far to be clean, such as amongst detainees (see PMID: 11547624). Group circumcision performed during coming of age ritual would fall into the same category.

    # 5 July 2009 at 9:39 am
  • peripheries said:

    I fixed the link, you can also visit the Avert website. The CDC which you quote also recommend following standard procedures. You are right that so far it is only an asssociation, not a correlation, but this is oftne the case in science. Hepatitis C has been showed to be transmitted through this way. I have myself a few tattoos and I can assure you that I would not get one if I was not sure that the equipment is squeaky clean! The risk is not zero. Again, it is up to people to decide, as said, there is no scale of risk associated to each of these factors because there is no fixed risk. It is a question of informed choice.

    # 5 July 2009 at 9:40 am
  • [him] moderator said:

    Good science deals with causation and not correlation. Hepatitis C is a poor surrogate for HIV acquisition and transmission risk as it is much more easily transmissible through nonsterile injecting equipment and hardly transmissible at all through unprotected sex.

    No risk is ever zero, but the risk of HIV transmission through tattooing is negligible. It is time for informed choice AND time to put this myth to rest. Thanks for the discussion.

    [him] moderator
    http://him.civiblog.org

    # 6 July 2009 at 2:53 pm
  • peripheries said:

    It is not that I would disagree with you, but a lot of good science is currently based on correlation and association, or the use of surrogate markers. Look at all the Genome Wide Association Studies looking for genes involved in metabolic diseases such as obesity, or mental disorder or even HIV. It's not the study that is good or bad but what one does with the results. And even when there is causation, it is not always universal, it depends on the model and for example, a lot of study done with mice are not valid in human. And as for the use of surrogate indicators, just look at the use of GDP to measure development.
    Back to your initial point, you will remember the Swiss statement about non-infectiousness of PLWHA under treatment and the following debate it triggers. As you said "the risk is negligible" but that's a subjective judgement.
    It is very complex and I am sure you know and understand that.

    I think we both made our point and will have to disagree on how we perceive risk.

    # 7 July 2009 at 8:32 pm