AIDS/HIV Transmission References

Title
     Proposal to develop a detailed safety program for general/laser surgical patients infected with AIDS.
Author
     Goldman L
Address
     Department of Dermatology' Naval Medical Center' San Diego' California 92134-5000'
     USA.

Source
Lasers Surg Med, 19(3):351-8 1996
Abstract
Medical health personnel have acquired serious and rarely fatal infections in the operating room from AIDS patients. Yet' there are no officially approved AIDS safety programs designed to protect medical health care personnel in the operating room. A sequential safety program is proposed beginning with the following steps: 1) evaluation and staging of the patient and associated complications; 2) protection of the major surgical and laser instruments; 3) use of an efficient evacuator system to avoid plumes of laser fragments from polluting the operating room environment; 4) protection of the operating room staff with special eye protection including helmets and shields' fluid-soak-resistant fabrics for garments' double surgical gloves' and special orderly trays with safety holders for syringes' needles' sharp instruments' and suture holders; 5) reporting and treatment of accidents' such as needlestick puncture wounds' that require immediate attention and an infectious disease consultation; 6) postoperative care' which includes providing medical health care personnel protection from bloody bandages' needles' and the infectious patient; and 7) and finally' the washing and sterilizing of contaminated instruments by medical health care personnel using face shields and masks' gloves' and protective fabrics for garments. Continued experience with this proposed safety program will determine its future value for AIDS surgical patients and for all health care workers.

Title
     Human immunodeficiency virus and the surgeon.
Author
     Hebra A; Adams DB; Holley HP Jr
Address
     Department of Surgery' Medical University of South Carolina' Charleston 29425.
Source
     J S C Med Assoc, 86(9):479-83 1990 Sep
Abstract
     To assess the exposure risks for surgeons and nurses treating HIV infected patients at the Medical University Hospital and the Charleston Memorial Hospital' a retrospective review of HIV positive patients who underwent surgical procedures from 1985-1988 was undertaken. During that period' 150 patients tested positive for HIV of which 30 (20%) underwent 19 surgical procedures. The prevalence of HIV infected patients at our institution has been increasing over the last two years. 5.3% of the patients tested were positive for the virus. Evidence of drug abuse was not a predictive factor of HIV infection but homosexuality was present in 57% of our patients. The mean age of the surgical group was 34 years. Seventy-three percent of the patients underwent minor operations and 27% had major surgical procedures. Almost half of the operations were performed to treat an AIDS-related complication or as a diagnostic aid in the workup of the AIDS patient. MaJor operation performed were for treatment of a co-morbid condition not related to the HIV infection.
     Only two patients had operations for trauma. Operative mortality was 10% but no death was directly related to surgical intervention. In addition to universal precautions in the pre and postoperative period' operating room personnel must follow established protocols in the conduct of the operation to ensure the safety of all staff.

Title
     Tests show that the AIDS virus is capable of being transmitted as a mist during certain
     surgical operations [news]
Author
     Hebra A; Adams DB; Holley HP Jr
Address
     Department of Surgery' Medical University of South Carolina' Charleston 29425.
Source
     Can Oper Room Nurs J, 86(9):27 1989 Feb-Mar

Title
     Considerations and controversies of AIDS.
Author
     Hebra A; Adams DB; Holley HP Jr
Address
     Department of Surgery' Medical University of South Carolina' Charleston 29425.
Source
     Todays OR Nurse, 86(9):20-6 1989 Oct
Abstract
     The statistical probability of seroconversion is proportional to the number of needlesticks incurred and the likelihood that the needlesticks will be with HIV infected blood. Careful adherence to recommended operating room practices, combined with meticulous attention to handling needles and sharps, should result in few, if any, cases of occupational HIV seroconversion among OR personnel. HIV testing is not feasible in the management of emergency patients; these are often the individuals at highest risk for HIV infection and over whom the surgical team has the least control. Non-operative treatment of HIV-infected patients is not an option; many procedures are performed either to enable the individual to lead a more comfortable, productive life or for diagnostic purposes.

Title
     Blood in saliva of HIV seropositive drug abusers: possible implication in AIDS transmission.
Author
     Piazza M; Chirianni A; Picciotto L; Tullio Cataldo P; D`Abbraccio M; Borgia G; Orlando R;
     Valletta G; Matarasso S; Vaia E
Address
     Istituto di Malattie Infettive' II Facolt`a di Medicina e Chirurgia' Universit`a di Napoli' Italy.
Source
     Boll Soc Ital Biol Sper, 67(12):1047-52 1991 Dec
Abstract
     We have studied hemoglobin concentration in saliva of anti-HIV positive and anti-HIV
     negative intravenous drug abusers (IVDA) and normal controls and the relationship     between hemoglobin concentration in saliva and number of CD4+ cells and clinical status of AIDS in anti-HIV positive IVDA. 120 anti-HIV positive IVDA' 112 anti-HIV negative IVDA and 116 normal healthy subJects not belonging to any risk group for HIV infection completed the study. Saliva was collected at awakening before brushing teeth and the concentration of hemoglobin was determined. Hemoglobin concentration in saliva in basal conditions is higher in anti-HIV positive IVDA with respect to anti-HIV negative IVDA (p less than 0.05) and controls (p less than 0.01). In anti-HIV positive IVDA hemoglobin concentration in saliva is higher in subJects with CD4+ cells less than 200/10(6) l with respect to subJects with CD4+ greater than 200/10(6) l (p less than 0.05) and in subJects with ARC/AIDS with respect to subJects with PGL or who are asymptomatic (p less than 0.01). SubJects with ARC/AIDS have a mean concentration of hemoglobin of 19 micrograms/0.1 ml saliva (range 0-153) which corresponds to 1.3 microliters of blood/ml saliva. If 10 ml of saliva are exchanged during kissing an average of 13 microliters of blood are transferred (110 microliters of whole blood at extreme range). Blood of symptomatic patients has an HIV titer of 7 TCID/microliters which for 10 ml saliva containing an average of 1.3 microliters blood/ml saliva corresponds to an average of 90 TCID (770 TCID at the extreme range).

Title
     Detection of HIV antibodies in saliva as a tool for epidemiological studies.
Author
     van den Akker R; van den Hoek JA; van den Akker WM; Kooy H; ViJge E; Roosendaal
     G; Coutinho RA; van Loon AM
Address
     Laboratory of Virology' National Institute of Public Health and Environmental Protection'
     Bilthoven' The Netherlands.
Source
     AIDS, 6(9):953-7 1992 Sep
Abstract
     OBJECTIVE: To evaluate the use of saliva specimens for the detection of HIV antibodies among high-risk groups in epidemiological studies. DESIGN: Testing of saliva specimens collected by different methods from individuals with known HIV status. The most reliable method was examined for its usefulness in a field study among a high-risk group.
     METHODS: Saliva samples were obtained either by using a cotton-wool roll (`Salivette`) or as `whole saliva`. HIV antibodies were determined using commercial enzyme-linked immunosorbent assays (ELISA). Confirmation was performed using a line immunoassay or an immunoblot assay. RESULTS: In `Salivette` samples, HIV antibodies were detected by ELISA in seven out of 22 seropositive individuals. In contrast, testing of `whole saliva` samples from 79 HIV-seropositive and 115 HIV-seronegative individuals resulted in a 100% correlation with HIV serum status. The positive reaction of 20 `whole saliva` specimens was confirmed in a line immunoassay' whereas in an immunoblot assay only seven specimens were positive, one negative, and 12 indeterminate. In an HIV prevalence study among drug users, 395 `whole saliva` samples were tested in two different ELISA. Both assays showed complete agreement in detecting 58 positive and 337 negative samples. All positive samples were confirmed by the line immunoassay. CONCLUSION: Our study demonstrates that `whole saliva` specimens are a good alternative to blood samples in epidemiological studies of HIV prevalence in high-risk groups.

Title
     Saliva key to AIDS treatment?
Author
     van den Akker R; van den Hoek JA; van den Akker WM; Kooy H; ViJge E; Roosendaal
     G; Coutinho RA; van Loon AM
Address
     Laboratory of Virology' National Institute of Public Health and Environmental Protection'
     Bilthoven' The Netherlands.
Source
     Dent Assist, 6(9):6 1988 Jul-Aug
Abstract

Title
     HIV surveillance by testing saliva.
Author
     Johnson AM; Parry JV; Best SJ; Smith AM; de Silva M; Mortimer PP
Address
     Academic Department of Genito-Urinary Medicine, University College, Middlesex School of
     Medicine, London.
Source
     AIDS, 2(5):369-71 1988 Oct
Abstract
     Saliva specimens were tested for HIV antibody (anti-HIV) by an immunoglobulin G (IgG) antibody capture radioimmunoassay (GACRIA) and three sensitive commercial assays. In tests on 460 seronegative subjects and 196 seropositive subjects GACRIA was 99.8% specific and 100% sensitive. The Wellcome HIV monoclonal and Abbott recombinant DNA enzyme-linked immunosorbent assays (ELISAs) were also highly specific (99.8%, 100%) but they were less sensitive (90.9%, 82.0%). The Fujirebio particle agglutination assay was sensitive (97.8%) but its specificity was poor (84.1%). In testing saliva specimens from populations with an anti-HIV prevalence greater than 0.5%, sampling by GACRIA alone could provide a good estimate of the true prevalence. For true prevalences less than 0.5% good estimates could only be obtained if positive GACRIA reactions were confirmed by another independent salivary assay. Salivary testing for anti HIV is a convenient and potentially an accurate epidemiological tool.

Title
     Decontamination of an HIV-contaminated CPR manikin.
Author
     Corless IB; Lisker A; Buckheit RW
Address
     University of North Carolina' Chapel Hill 27599-7460.
Source
     Am J Public Health, 82(11):1542-3 1992 Nov
Abstract
     There has been a concern that the number of persons engaging in cardiopulmonary
     resuscitation (CPR) training could decline because of questions about human
     immunodeficiency virus (HIV-1) transmission. We investigated the theoretical possibility that a CPR manikin might serve as a fomite for HIV-1 transmission. Decontamination protocols were tested by using elevated levels of virus and decreasing decontamination times using propanol. Even under these compromising conditions, however, decontamination was effective.