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PREVENTING TRANSMISSION OF HIV INFECTION: UNDERSTANDING HOW HIV IS SPREAD: PREVENTING TRANSMISSION DURING HOME CARE-PREVENTING TRANSMISSION OF INFECTIONS OTHER THAN HIV
People with HIV infection are susceptible to infection by a multitude of other microbes. These microbes cause what are called opportunistic infections. The most common opportunistic infections are Pneumocystis pneumonia, thrush, infection disseminated throughout the body caused by either cytomegalovirus or Mycobacterium avium, and a brain infection called toxoplasmosis. People commonly want to know whether the caregiver can also be infected by these opportunistic infections. The short answer is: with rare exceptions, no.
Most of these opportunistic infections are caused by microbes that we all come in contact with every day. People with HIV infection usually do not develop opportunistic infections until relatively late in the disease after their immune systems have become profoundly impaired. The caregiver's immune system does not permit such organisms to flourish. In other words, none of these infections can be transmitted from the person to the caregiver either in the home or in the hospital.
Pregnant caregivers are sometimes worried about exposure to people with cytomegalovirus, but most authorities believe these concerns are unjustified.
In fact, the person with HIV infection is not a significant source of opportunistic infections even for another person with HIV infection. The reason is that most of these microbes are and always have been everywhere around us, and everyone has been exposed to them for a long time.
Exceptions to the rule. Some infections may be transmitted to the caregiver, and to avoid these infections, the caregiver should use special precautions.
The most important exception is tuberculosis, which is caused by a bacterium called Mycobacterium tuberculosis. Mycobacterium tuberculosis is related to another bacterium that people with HIV infection are prone to, Mycobacterium avium-intracellulare, or MAI, which causes infections throughout the body. MAI is not contagious—that is, it cannot be spread from person to person. Mycobacterium tuberculosis, however, is contagious.
Tuberculosis has been found in as many as 5 to 10 percent of the people with AIDS in cities like New York, Newark, and Miami. It can be transmitted to others the same way all cases of tuberculosis are transmitted. The people at greatest risk are those who live within the same household. Usually people become infected by inhaling the droplets in the air after the infected person has coughed. Most people, however, must be in the same household for at least a month before becoming infected.
Whenever a case of tuberculosis is detected, medical authorities evaluate others in the same household. The evaluation starts with a skin test. If the skin test for tuberculosis is positive, the evaluation proceeds to the next step, a chest x-ray. Once tuberculosis is treated with drugs, the infected person rapidly becomes noncontagious. For this reason, the main threat of tuberculosis comes from the person whose tuberculosis has not yet been detected or treated.
Another infection that is an exception is hepatitis B. Most people with hepatitis B are not aware they have it; they develop antibodies to it and are subsequently protected from infection. However, about 5 to 10 percent of people with hepatitis B will develop a persistent infection, and therefore may infect others for many years. Some people with persistent hepatitis will develop a liver disease called chronic active hepatitis that may eventually result in cirrhosis.
The virus that causes hepatitis B is transmitted the same way HIV is: by sexual contact, by blood contact, or by passage from mother to infant. Therefore, the activities that carry a risk of infection with HIV also carry a risk of infection with the hepatitis B virus. People at greatest risk for hepatitis B are those who have homosexual sex, who use drugs intravenously, or who have hemophilia. Like HIV, hepatitis B may be also transmitted to someone exposed to the blood of an infected person.
Hepatitis B has three features worth emphasizing:
- Hepatitis B virus is transmitted much more efficiently than HIV. A needlestick injury with blood that contains the hepatitis B virus is twenty times more likely to transmit hepatitis B than a needlestick injury with blood that contains HIV is to transmit HIV infection.
- The same guidelines for preventing transmission of HIV through blood and body fluids apply to preventing transmission of hepatitis B.
- A vaccine can prevent infection by the hepatitis B virus. The hepatitis vaccine is readily available, though it is expensive.
Outside of tuberculosis and hepatitis, the infections that could conceivably be transmitted from the person with HIV to a caregiver are salmonellosis, herpes simplex infection, herpes zoster infection, and cryptosporidiosis. If the caregiver is otherwise healthy, these infections may cause a temporary disease that is not serious.
Salmonellosis is an infection of the intestine by bacteria called salmonella. The main symptom of salmonellosis is diarrhea. Salmonellosis is relatively unusual, and transmission to others is relatively infrequent.
Cryptosporidiosis is also an infection of the intestine, but is caused by a parasite. The main symptom of cryptosporidiosis is also diarrhea. It is transmitted by lapses in personal hygiene; that is, small amounts of feces on the hand carry the parasite to someone else's hand, and then to that second person's mouth.
Herpes simplex, usually known as "herpes," causes a blister on the skin, most commonly on the mouth or genitals, though people with advanced HIV infection can also have herpes over much of their bodies. The caregiver can get herpes by touching the blisters, and can avoid transmission easily by wearing gloves when touching the areas with sores until the sores are crusted over.
Herpes zoster, also called shingles, is caused by the virus that causes chickenpox. The virus is transmitted when people inhale it. However, most older children and adults have had chickenpox, even if they don't remember it, and thus are protected by antibodies against the virus. Those who are concerned about herpes zoster are urged to have a blood test to see if they have antibodies to herpes zoster; and to be safe, they should avoid going into the same room as the infected person until the sores are crusted over.
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HIV
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