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HIV Prevention (Expert Forum)
blood exposure in mouth
Answered by
University of Washington
Seattle - WA
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No questions will be accepted on the treatment of HIV/AIDS or its complications, viral load, and similar topics. If you have questions about a specific STD other than HIV/AIDS, please visit the STD Forum. Questions that do not pertain to the above topics will be removed from the forum.
If you have not done so, please review other threads in our archives for questions similar to yours and Dr. Handsfield's replies. Questions that duplicate other frequent ones, for which abundant replies exist, and that have little educational value for other forum users, will be DELETED WITHOUT RESPONSE. YOUR PAYMENT WILL NOT BE REFUNDED. The most common examples of such questions are those about low risk exposures to HIV, such as oral sex, condom- protected intercourse hand-to-genital exposure, and nonsexual contact with possibly infected blood or body fluids as well as symptoms of early HIV infection.
blood exposure in mouth
by justonce, Jan 16, 2007 12:00AM
Doc,
My story, I had an hiv + male partner. We engaged in protected sex once (vaginal intercourse) and had protected
oral sex once. That was several months ago and I since
tested neg. We have agreed not to engage in any further
sexual activities but on 1/2/07 we were in bed just holding
each other when I bit his nipple just playing around and
drew blood into my mouth, I swallowed without thinking,
several minutes later rinsed with water. He probably
bled from the nipple for a few seconds (several drops).
He is pos x 12 years and tends to be well controlled with meds.
at his last blood test he was at 159 viral load which was a
couple weeks before this incident. After I bit him I tasted
a small amount of blood on the very back of the tounge. I have
good oral hygiene, no open cuts or sores. I did brush my teeth
about 1.5 hours prior to this. We have no other risks, no
other std's and general good health. I went to the ER the following day out of fear and was prescribed a 28 day expanded 3 drug nPEP. The ER doc looked at me like I was already a goner.... so Doc, what are my chances? I read it's 1/1000 for
a blood splash to a mucous membrane. If so, should I expect
some reduction due to the pep (it was started within 36 hours of exposure). The relationship tanked due to the stress of all this. Also, when do you think I should follow up with my pcp?
Thanks for your help.
My story, I had an hiv + male partner. We engaged in protected sex once (vaginal intercourse) and had protected
oral sex once. That was several months ago and I since
tested neg. We have agreed not to engage in any further
sexual activities but on 1/2/07 we were in bed just holding
each other when I bit his nipple just playing around and
drew blood into my mouth, I swallowed without thinking,
several minutes later rinsed with water. He probably
bled from the nipple for a few seconds (several drops).
He is pos x 12 years and tends to be well controlled with meds.
at his last blood test he was at 159 viral load which was a
couple weeks before this incident. After I bit him I tasted
a small amount of blood on the very back of the tounge. I have
good oral hygiene, no open cuts or sores. I did brush my teeth
about 1.5 hours prior to this. We have no other risks, no
other std's and general good health. I went to the ER the following day out of fear and was prescribed a 28 day expanded 3 drug nPEP. The ER doc looked at me like I was already a goner.... so Doc, what are my chances? I read it's 1/1000 for
a blood splash to a mucous membrane. If so, should I expect
some reduction due to the pep (it was started within 36 hours of exposure). The relationship tanked due to the stress of all this. Also, when do you think I should follow up with my pcp?
Thanks for your help.
Doctor's Answer
by H. Hunter Handsfield, M.D., Jan 16, 2007 12:00AM
, Jan 16, 2007 12:00AM
Your risk is low from this event. The indications for PEP are borderline; many providers would not recommend it, or would leave the decision up to the patient. Swallowing blood is no higher risk than mucous membrane exposure, maybe lower; in general, swallowing HIV in any fluid is pretty low risk. And with your partner's very low viral load, the chance you were infected certainly was much lower than 1 in 1000.
I cannnot give direct personal advice for your care in this situation. Presumably the ER referred you to a provider experienced in HIV infections and in PEP. If not, they should have. Follow up with that provider, or find one yourself. (You could phone the local health department or medical society to find someone, such as an infectious diseases specialist or other provider skilled in HIV care and PEP.) In the meantime, continue your PEP until advised otherwise--but mellow out, knowing your risk of HIV was very low even without PEP.
Good luck-- HHH, MD
I cannnot give direct personal advice for your care in this situation. Presumably the ER referred you to a provider experienced in HIV infections and in PEP. If not, they should have. Follow up with that provider, or find one yourself. (You could phone the local health department or medical society to find someone, such as an infectious diseases specialist or other provider skilled in HIV care and PEP.) In the meantime, continue your PEP until advised otherwise--but mellow out, knowing your risk of HIV was very low even without PEP.
Good luck-- HHH, MD
and I have been exposed. He placed a call to the powers that be
in infection control (assumed to be an infectious disease
specialist) and loaded me with Combivar (SP) and another drug
I think is AZT (which my guy is allergic to).
I just want to know if I have the 1/1000 chance that is
cited in all the studies published or if I have better odds.
These drugs are tough to take but I'm 1/2 way home. If indeed
they do reduce transmission by some 80% I'll stick with them.
I was also wondering when I should follow up with a test.
I will follow up. However, if you'd
please.. Are you saying that swallowing *** or any other
body fluid is about the same risk as swallowing blood?
Is it true that saliva inhibits the HIV virus?
Is an exposure in the mouth less than unprotected vaginal sex?
When should I follow up? I was refered to my Primary Doc not
a disease specialist. Is it imperitive that I see her now or
can I wait until I finish the meds ( I already have an appt in
a couple weeks). I understand if you can not answer questions
regarding treatment.
Thanks Doc, your words are reassuring to me. You have provided
some relief to a lot of people ...thanks again...
Saliva inhibits HIV. Mouth exposure or swallowing is much lower risk than unprotected vaginal sex.
People on PEP should be seen at least once during treatment, usually a couple of times, to check for side effects and general assessment. Ask your provider what s/he recommends; or if s/he isn't up to speed on PEP, ask for referral to someone who is.
Glad to help. Take care-- HHH, MD
Good luck - I hope your a-ok, I think you will be!
but it appears that there is a different make up of the
virus in milk vs blood. I just hope we are not comparing
apples to oranges. Doc, this is not a challenge to what
you posted, I'm just frightened.
Conf Retrovir Opportunistic Infect 2004 Feb 8-11; 11:(abstract no. 93)
Edwards B, Ghosh M, Sabbaj S, Rhodes A, Decker D, Goepfert P, Aldrovandi G; Univ. of Alabama at Birmingham, USA and 2Childrens' Hosp. Los Angeles, CA, USA
BACKGROUND:
Transmission of HIV via breast milk is a significant source of pediatric infection, yet the majority of infants do not acquire infection through this route. This latter finding may be due to the low levels of HIV RNA in breast milk compared with plasma. We therefore hypothesized that the magnitude and quality of T cells in breast milk are different than the peripheral blood compartment as an explanation for the lower viral load in the former compartment.
CONCLUSIONS: T cells found in the breast milk compartment express a highly activated/effector phenotype that preferentially migrate to this area. These findings may not be specific for HIV, as other antigen responses also appear increased in breast milk. Nevertheless, our data are consistent with the hypothesis that increased numbers of activated HIV-specific CD8+ T cells result in lower viral RNA levels in the breast milk than peripheral blood compartments