Klarinet Archive - Posting 000174.txt from 1999/01

From: "Diane Karius, Ph.D." <dikarius@-----.edu>
Subj: Re: [kl] HIV via saliva
Date: Wed, 6 Jan 1999 12:11:24 -0500

In response to Neil's post regarding HIV and saliva (included below):

Because the viral load of HIV in the blood (translation: the number
of HIV "particles" in the blood) is very low (virtually
undetectable unless you know where to look), the infection rate
from an accidental needlestick (with a contaminated needle in a
healthcare setting) is currently 0.2 - 0.3%. Since the HIV present
in saliva is NOT derived from the epithelial cells of the mouth, but
enters the saliva from the blood (saliva is a filtrate of blood
that is then modified by the salivary glands), the amount of HIV
present in saliva is still less than that found in the blood
(although it had been assumed that HIV could be found in the saliva,
it was actually rather difficult to prove because of the very low
numbers). As noted in Neil's post you would have to consume
a large amount of saliva all at once before you got infected, barring
incredibly bad lack.

As to the issue of cuts in the mouth (common enough) - since the
viral load of HIV in the blood is so low, the risk of infection from
that route is probably not any greater than the 0.2 - 0.3% rate for
accidental needlestick. (As an aside - the 0.3% infection rate for
accidental needlestick reflects the time before the routine
administration of the new immediate treatments that are extremely
effective in reducing the transmission of HIV following accidental
exposure (variations of these are being used in neonates to
prevent/miniminze maternal to fetal transmission of the virus).

Having said all that - in complete honesty there are some other
viruses that I am whole lot more concerned about. The preferred
route for transmission of several viruses (e.g. Ebstein-Barr) is
saliva. These probably won't kill you but can make your life pretty
miserable. Although it is not easiest way to catch hepatitis B and
C, the risk of catching either of those via saliva is greater than
the risk of catching HIV (by comparison, accidental needlesticks of
hep. B infected blood carry a 10 - 30% chance of transmission).

(For the record, the risks of infection cited were collected from the
MMWR (put out by the CDC) (HIV and Hep. B); Hep C. info. was
collected from multiple sources in the recent literature and the NIH
consensus report). If any one wants I can pull the specific
references from the stuff I prepared for our medical students when I
discussed univeral precautions with them.)

> It's an interesting issue, both medical and political. I've been
> tested for HIV several times (always negative), and I've known
> for many years (via college coursework) that HIV is, in fact,
> present in human saliva. I've always noticed, when at an HIV
> testing clinic, that every piece of educational material, in-
> cluding large wall posters, lacks any statement concerning the
> presence of HIV in saliva. Naturally, all of the literature
> addresses blood and needles and direct sexual activity, but
> never anything about saliva. When I inquired about the ommission,
> I was given a humorous, albeit slightly disturbing answer:
>
> "You would have to consume approximately 5 gallons of the saliva
> from an HIV-infected individual -- all at once -- in order to
> contract HIV. Any less salivary fluid than that, and your own
> immune system kills the virus instantaneously." This is an
> indication of how low the concentration of HIV is in saliva.
> I was told that because of this information, educational lit-
> erature about HIV almost never identifies saliva as a means
> by which the disease may be contracted, lest the public act
> on -- and escalate -- paranoia regarding the issue and cause
> a major panic.
>
> The logical application to clarinet, of course, is that playing
> on the mouthpiece of an HIV infected individual is an extremely
> unlikely cause for concern with regard to their saliva. This
> does not, however, speak to the issue of open mouth sores or
> cuts (i.e.; on the tip of the tongue from lots of articulation
> practice) and the transmission of the disease via actual blood.
> I'm not making any intentional implications with this statement,
> but invite Diane Karius and any other M.D. types on the list
> to respond.
>
> Neil
>
> -------------------------------------------------------------------------
> Unsubscribe from Klarinet, e-mail: klarinet-unsubscribe@-----.org
> Subscribe to the Digest: klarinet-digest-subscribe@-----.org
> Additional commands: klarinet-help@-----.org
> Other problems: klarinet-owner@-----.org
>
>
Diane R. Karius, Ph.D.
Department of Physiology
University of Health Sciences
1750 Independence Ave.
Kansas City, MO 641o6-1453
email: dikarius@-----.EDU

-------------------------------------------------------------------------
Unsubscribe from Klarinet, e-mail: klarinet-unsubscribe@-----.org
Subscribe to the Digest: klarinet-digest-subscribe@-----.org
Additional commands: klarinet-help@-----.org
Other problems: klarinet-owner@-----.org