elevated risk via HSV-2/ARS medical study question

I have been reading these forums for a while now since posting myself and there is a few nagging questions that bother me so here goes.

1. The increased risk of HIV infections as a result of pre-existent HSV-2; Dr. Handfeld estimates 2x, Dr Hook estimates 3x, and several other med sources say 2-4x. I'll assume worse and use 4x (which personally sounds like a hell of alot of risk to me). It is also estimated that 1 in 5 sexually active Americans are infected with HSV-2. So basically 1 in 5 Americans (I will assume mostly heterosexual non injection drug using) are at 4x the risk for HIV!? I guess my question is why you very rarely see med professionals address HSV-2 infection when they are talking about HIV risk, shouldn't it be up there with MSM, injection drug using, and regular high risk partners as a significant risk factor? Even on this forum it rarely comes up except when a client brings it up. Am I right in saying that a large population in the US that normally wouldn't be is at a much elevated risk for HIV due to this common infection or am I blowing this out of proportion? Isn't this a big deal?

2. In discussing symptoms with clients, you often refer to a study where only 1% of patients being treated for ARS symptoms actually had it. Were the test group for this study ppl who a) developed classical ARS symptoms 2-3 weeks after a "risky"  exposure or b)just patients who came in for ARS compatible symptoms with or without mentioning any risk factor. I ask because if it is more like option a. that is pretty impressive evidence for the unreliability of symptoms in diagnosing HIV infection, where as b. doesn't seem near as impressive as 1,000s of ppl must come in every day for fevers, rashes, etc. Please clarify if possible, I'm really curious about this one - I can tell you from experience it isn't the "ARS" symptoms that scare  near as much as the timing of their development after a "risky" experience.

I appreciate your answer and thank you again

[Edward W Hook, MD]

Brief answers to your two questions:

1.  A four-fold increase risk when the initial risk is 1 in 1000 becomes 1 in 250, sill less than one-half of one percent, if the person one is having sex with is HIV infected which, statistically is also very unlikely.  Thus, combining these two figures, the risk is still quite low and lower than your lifetime risk of dying in a car accident (I read yesterday that your lifetime risk of dying in a car accident is 1 in 500).  In addition, I feel as though we do address this issue of HSV-related risk regularly. I'm sure if you look over our archives you can find this fact mentioned over 100 times.  

2.  The study was done with persons coming into the ER for flu-like illness.   This makes them sicker than most of the folks who have flu-like illness not severe enough to make them go to the emergency department but at lower risk than those who have sex with a high risk partner.  On the other hand, most of those who ask about their risk on this site have not had sex with a high risk partner (High risk partners are those with HIV infection. Partners of unknown status, particularly heterosexual partners or even CSWs, are not particularly high risk.)

Bottom line, you use the data you have and put into context with the description of the clients concern and our combine 50 years of studding the disease and personal experience taking care of persons with and at risk for HIV.  You do not have to believe us if you like.   EWH

[mjd83]

I certainly do believe everything you and Dr. Handsfeld say on this site and don't at all question your expertise or experience and apologize if I came off that way. I was more so commenting on how it seems strange that the medical community focuses on MSM and drug use and seems to sometimes overlook what seems to me to be a more common and widespread HIV risk elevating cause (albeit a lesser numerical mulitiplier)..

I am a little confused about your answer to the ARS question. I guess what I was asking was were the subjects in this study people who actually thought they had ARS (kind of like half the clients on this forum) or were they just people who showed up with a really bad case of the flu? I'm just trying to figure out whether the study was saying a)1% of bad flu cases are ARS or b) that 99% of people who were convinced they had ARS had it wrong.

Thanks again, you really helped with me with anxiety a while back but now I'm interested and curious about HIV infection and find the information on this site to be generally unbiased and extensive.

[Edward W Hook, MD]

Than answer is that 1% of bad flu cases are HIV - they were seeking care for the flu.  From my experience on this forum, I would say that well over 99% of persons who think they have ARS do not.  Most persons who have ARS have no idea that this is what they have  (in fact, of the people Ive seen with ARS, none has worried that that is what they might have had).  EWH

[dynamo17]

CDC says that female to male transmission is b/w 1:1000-3000, why do you quote the most conservative Dr Hook

[nursegirl6572]

Dr. Hook has never done anything but present accurate, honest and realistic information, not based on reading websites...but from REAL experience and expertise in the field.

I don't think you and half of the other posters have an inlking of a clue of what the above means.  It means that they see it EVERY day....they have seen just about every scenario under the sun when it comes to this disease.  When they post what the "norms" have been in their experience...that is as good as gold.  THAT would be end of my search if I were one of you.  It doesn't get any better than that.

While the CDC is a reputable agency...their job is present information in a "numbers" fashion based on the information provided TO them from others.  THEIR figures will always be uber-conservative, whereas the good docs here base their info on reality and decades of experience with this disease.  Also, the CDC deals with all infectious diseases, not JUST HIV.  

You honestly need to move on...you are becoming quite unhealthy for the other readers in these forums.  I mean that sincerely out of concern for the impressionable anxious people who are likely to read your posts.

(Sorry to insert myself, Dr. Hook, couldn't help it.)

[Edward W Hook, MD]

Thanks nursegirl.  Bottom line, I use the figure that work for me.  If you want to quibble about how much more 1 in 1000 is than 1 in 2-3000, you've missed the point.  If your the one - bad news but, more nearly everyone who has a single exposure, the risk is very, very low.  EWH

[mjd83]

This use to bother me too until one day I realized that 1/1000 = .1% and 1/3000 = .0333% and I realized we are arguing over .067% difference in probability! I don't know about you but for me .067% exists only in the theoretical and makes no practical difference. Consider the most high risk sexual experience possible (you are the receptive partner to anal sex with an HIV positive partner) and even there the risks are quoted as 1/100 which is still a 99% chance per exposure that you will not be infected! (all other variables aside.) I would think based on this, even MSMs typically are infected over several exposures and not typically just one. What I gather from this forum is HIV has alot of variables and I would assume from what all I've seen is that a series of unlikely events have to coincide for one person to infect another (especially with vaginal sex). It's not just as simple as sneezing a cold virus to another person.  

I know that in the army we assess risk not only on probability but also severity (example: a 1% transmission rate for a cold virus would be considered very low risk but for HIV is high.) and I wonder if the medical community doesn't do the same. It is for this reason that I applaud Dr. Hook for usually quoting the conservative figure, always assuming the worst is a safe way to assume especially with something as catastrophic as HIV/AIDS.

It is ironic that I started this very post with similar reasoning that you are exhibiting now and think I have finally gotten Dr. Hook's point. I don't think I'm going to play Russian roulette whether the pistol has 1,000  or 3,000 chambers how about you? Dr. Hook please correct me if any of the above is faulty or inaccurate reasoning.