HIV TRANSMISSION

TRANSMISSION
• Sexual contact (both heterosexual and male-male)
• Blood and blood products
• Infected mothers to infants intrapartum, perinatally
• Breast milk
SEXUAL TRANSMISSION
• Heterosexual transmission is the most common mode of infection.
• HIV has been demonstrated in seminal fluid both within infected
mononuclear cells and in cell-free material.
• It was also demonstrated in cervical smears and vaginal fluid.
• There is an elevated risk of HIV transmission associated with
unprotected receptive anal intercourse (URAI) among both men and
women compared to the risk associated with unprotective receptive
vaginal intercourse. (approx. 1.4%)
Two modalities of infection from anal intercourse:
1. Direct inoculation into blood in cases of traumatic tears in the
mucosa
2. Infection of susceptible target cells, such as Langerhans cells, in the
mucosal layer in the absence of trauma.
• Infection with microorganisms such as Chlamydia trachomatis,
Neisseria gonorrhea and Trichomonas vaginalis also are associated
with increased risk of transmission of HIV infection.
• Treponema pallidum, Haemophilus ducreyi and HSV are important
cause of genital ulcerations linked to transmission of HIV.
• The quantity of HIV-1 in plasma is a primary determinant of risk of
HIV-1 transmission.n
• Circumcision is associated with a lower risk of acquisition of HIV
infection.
• Oral contraceptives: due to drug-induced changes in the cervical
mucosa, rendering it more vulnerable to penetration by the virus
• Adolescent girls are more susceptible
• Oral sex is much less efficient MOT than in anal or vaginal intercourse.
• Association of alcohol, illicit drug use with unsafe sexual behavior,
both homo- and heterosexual leads to an increased risk of sexual
transmission of HIV.
• Methampethamine and other so called club drugs have been
associated with risky sexual practices
TRANSMISSION THROUGH INJECTION OF
DRUGS
• HIV can be transmitted to injection drug users (IDUs) who are
exposed to HIV while sharing injection paraphernalia.
• Parenteral transmission of HIV during injection drug use does not
require IV puncture; subcutaneous “skin popping” or intramuscular
“musculing” injections can transmit HIV as well
• Risk of infection increases with the duration of injection drug use,
number of partners whom paraphernalia are shared.
TRANSMISSION BY TRANSFUSED BLOOD AND
BLOOD PRODUCTS
• HIV can be transmitted to individuals who receive HIV-contaminated
blood transfusions, blood products or transplanted tissue.
• Blood products: whole blood, PRBC, platelets, leukocytes and plasma
MOTHER-TO-CHILD TRANSMISSION OF HIV
• can be transmitted from an infected mother to her fetus during
pregnancy, during delivery or by breast-feeding.
• HIV can be transmitted to the fetus during the first or second
trimesters of pregnancy. However, maternal transmission to the fetus
occurs most commonly in the perinatal period.
• Breastfeeding is an important modality of transmission of HIV
infection. Risk factors of transmission include detectable levels of HIV
in breast milk, the presence of mastitis, low maternal CD4+ T cell
counts, and maternal vitamin A deficiency.
TRANSMISSION BY OTHER BODY FLUIDS
• There is no convincing evidence that saliva can transmit the infection.
• Submandibular saliva reduces HIV infectivity by stripping gp120 from
the surface of virions, and that saliva-mediated disruption and lysis of
HIV-infected cells occurs because of the hypotonicity of oral
secretions.