HIV transmission modes

1st December is World AIDS Day

On this occasion, Team MyOPD thought of clearing some misconceptions and providing additional information by talking to Dr. Bharat Purandare who specializes in the field of HIV care.

Dr. Purandare explains with great detail steps you need to take while saving a bleeding person on road, HIV transmission modes and much more… Read on…

Dr. Bharat Purandare, Infectious Diseases Practitioner in Pune. Specializes in treatment of HIV

Team MyOPD: How has been your experience treating HIV+ patients? Is the condition in India changing with respect to acceptance within the family about the positive status?

Dr. Purandare: I have been into HIV/AIDS practice since past 12 years now. I began my practice in an era when effective anti HIV drugs (called anti retroviral drugs) were very costly; the treatment of HIV was out of reach of common man. We only had Septran, a very basic antibiotic at our hand to treat these patients. People used to shy away with the name of HIV and the disease had a lot of stigma in the society. Even doctors used to reject HIV positive patients for treatment and they were mostly treated by junior or less experienced doctors. In the hospitals, HIV positive patients faced discrimination; they used to get beds which are in the corner; in non-airy, poorly lit, unclean areas. If a female patient with HIV infection got admitted, the relatives used to run away after admission leaving the patient at the mercy of hospital staff, without any food or medications.

Over past 10-15 years, the scenario has gradually changed. The anti retroviral drugs are now available at reasonable price, even a rickshaw-wala now can easily afford it. The safety profile of drugs has improved and so is their efficacy. The knowledge of treatment of HIV infection is now widespread and even a rural doctor can treat these patients in his own set up. HIV positive people are living longer, leading a healthy life and earning for their families. Social outlook is changing. HIV positive people have come together, and they have formed many self help groups and non-governmental organizations (NGO’s). The acceptance of HIV positive status of a person in his own family is growing. What was most surprising to me is that I found some HIV negative persons voluntarily coming forward to marry their HIV positive partners, whom they loved, in recent years.

Team MyOPD: We know from TV ads that HIV has just 3 modes of transmission. However, there are rumors being circulated about infection from fast food outlets with food being prepared by an infected person who has a cut on his finger. Can you shed some light on this?

Dr. Purandare: There are only four known modes of transmission:

  1. From an infected partner to uninfected partner through unprotected sexual intercourse.
  2. From an infected mother to her baby (called MTCT or mother to child transmission)
  3. Through infected blood and blood products (when not properly tested).
  4. Through contaminated needles and syringes (when not properly sterilized).

It is unlikely that HIV transmission will occur through fast food outlets with food being prepared by an infected person who has a cut on his finger or via soft drinks in which infected blood is mixed by a worker. I believe such news are spread just to create panic and confusion and should never be believed.

Team MyOPD: Is there a minimum blood or fluid criteria required for the transmission to happen, like say 2ml of infected blood needs to go in blood stream for the non infected patient to turn HIV+?

Dr. Purandare: There is no defined quantity of blood which is minimum or required for HIV transmission to occur. The virus is microscopic, 100 nanometers in size and theoretically a single virus particle can effect transmission.

What is known is that there are certain factors associated with increased risk of transmission.
The transmission risk increases when a person gets exposed to a large quantity of blood or infected fluid (either a splash of blood/bloody fluid or a bold prick with a hollow bore needle), particularly when the source patient is untreated or having an advanced stage of HIV infection. As regards the risk of sexual transmission, the risk of transmission is higher when an individual performs unprotected receptive anal or vaginal intercourse or when active genital ulceration or infection is present at the time of sex, or when an individual has multiple sexual partners.

Team MyOPD: How long does this virus stay alive outside the body? Is there any quantifiable measure?

Dr. Purandare: HIV virus can not stay alive for a long time outside human body. When the blood or infected fluid dries up, the virus is likely to die. Some experts suggest that the virus can remain alive only up to a few minutes in dried secretion. The virus is easily killed by high temperatures or simple disinfectants such as bleaching powder, sodium hypochlorite and glutaraldehyde. The virus has an outside shell made up of phospholipids. The phospholipids are easily soluble in soap solution. So a simple measure such as thorough hand washing with soap and water can kill the virus on the hand by dissolving its shell.

Team  MyOPD: You see a road accident and a bleeding person. What safety measure should be adopted by the person who is offering help?

Dr. Purandare: It has been proven beyond doubt that offering help and first aid to a bleeding person in the first hour of accident (THE GOLDEN HOUR), saves lives. When we are faced with such a situation, we need to offer help and provide medical aid to the bleeding person without second thoughts. When there is likely exposure the blood or blood-stained clothes or body areas, rubber gloves should be used. Sometimes gloves may not be available, and then clean cloth can be used as a barrier. If hands get contaminated with blood somehow, then hand washing with plenty of soap and water should be done thoroughly after exposure as soon as possible.

Team MyOPD: What would be your advice to patients who are dealing with this condition?

Dr. Purandare: My advice for HIV infected individuals will be to seek medical care as soon as they know their diagnosis. There is no point in delaying the treatment as it brings only suffering. Any good doctor, reasonably trained in HIV care will be able to provide them appropriate care while maintaining their right of confidentiality. The infected person needs to take antiretroviral drugs extremely regularly lifelong under supervision of their doctor and intermittent testing for treatment response is required. Anti retroviral drugs are available through government program free of cost and also in private health sector at reasonable costs. It is important that they disclose their HIV status to their sexual partners and use barrier contraceptives i.e. condoms at every intercourse. HIV positive pregnant patients must remember that very effective treatment is available both for themselves and the newborn baby so that mother to child transmission can be prevented. Breast milk can contain HIV virus and breast feeding can increase the risk of mother to child transmission. Infected persons should avoid blood or organ donation, needle sharing and sharing of shaving equipment or toothbrush. I also plead them not to fall prey to any advertisements claiming cure of HIV by ayurvedic or unani or any novel form of treatment. As of now, HIV infection can not be cured but can be well controlled (like diabetes) with currently available anti retroviral drugs.

Team MyOPD: What would be your advice to relatives of these patients? Any extra precautions that they should take at home?

Dr. Purandare: My advice to the relatives of HIV infected individuals will be to provide them emotional and social support. These individuals are fighting with a difficult disease and need our help. They should avoid any discrimination during day to day contact with HIV positive persons. There is no need to keep their beds, utensils or clothes separately. HIV is not present in sweat, saliva, tears, urine or stools unless these secretions are visibly contaminated with blood. HIV is present in blood, semen, vaginal secretions and breast milk. Exposure to these bodily fluids of infected individuals should be avoided. HIV is not spread by casual contact, eating or sharing food with infected persons or through mosquito or bed bug bites. Relatives should positively pursue the patients to takes drugs regularly and follow up with their doctors. HIV infected people have right to live, receive medical care and maintain their dignity. It is our collective responsibility to be sensitive to their needs.

Team MyOPD: Thank you Dr. Purandare for your time and detailed discussion. (Emphasis i.e. bold and underlined done by Team MyOPD to highlight important points in the article)

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