HIV/AIDS: Etiology and Oral Manifestations

Coming in contact with another person's blood puts one at risk for these infectious fluids coming in contact with one's own blood. There are some behaviors that put one at greater risk than other behaviors.

HIV transmission may occur during practices such as tattooing, blood-sharing activities such as "blood brothers" rituals, or any other type of ritualistic ceremonies where blood is exchanged or unsterilized equipment contaminated with blood is shared. HIV can also be transmitted from mother to infant during the birth process.

HIV is transmitted through direct contact with infected blood or body fluids. HIV is not transmitted through the air. Sneezing, breathing and coughing do not transmit HIV. Touching, hugging and shaking hands do not transmit HIV. HIV transmission is not possible from food in a restaurant that is prepared or served by an HIV-infected employee.

Case Study #1

Mr. R. is a middle-aged married male computer salesman who was transported to the ED after being found unresponsive in his apartment by a neighbor. Following a thorough exam the provider suspected a possible drug overdose, which was confirmed when a urine drug screen was positive for cocaine. Once stabilized, the staff offered him an HIV test. Mr. R. adamantly refused the test saying that he did not have any risk factors. The provider suspected this was not true and proceeded to perform a social history. Eventually, the provider was able to solicit answers that indicate Mr. R. is at risk for HIV: he has been sexually active since high school and has not always used condoms; while he is primarily heterosexual and has been married for almost 15 years, he has occasionally located men on the internet that he met for dates; he has never used intravenous drugs, but does share straws when using cocaine; he was incarcerated for assault when he was younger, and while in jail had used a common needle to give himself a tattoo.

Mr. R. thought that since he had only used drugs with people he knew and had sex with healthy looking men he did not have risk factors for HIV. He also thought that someone would have found out he was HIV positive during a recent hospital admission when he had labs drawn daily prior to and after major surgery.

The provider convinced Mr. R. that he should have an HIV test based on the results of his assessment. He provided him with education focusing on routes of transmission and appropriate barrier use. He explained the risk of having unprotected sexual relations and the fact that you cannot tell someone has HIV/AIDS by they way they look. The test results were negative, and the provider stressed the importance of retesting if he engaged in more high risk behaviors.

No cases of HIV transmission have been linked to sharing computers, food, telephones, paper, water fountains, swimming pools, bathrooms, desks, office furniture, toilet seats, showers, tools, equipment, coffee pots or eating facilities However, personal items, which may be contaminated with blood, including but not limited to razors, toothbrushes and sex toys, should not be shared.

There have been no cases of HIV transmission by children playing, eating, sleeping, kissing and hugging.

To date, there have been less than a dozen known cases of HIV transmission that have occurred in household settings in the U.S. and other countries. Reports of these cases have been thoroughly investigated by the CDC. The researchers determined that the transmissions were caused by sharing a razor contaminated with infected blood, the exposure of infected blood to cuts and broken skin, and possibly deep kissing involving a couple who both had bleeding gums and poor dental hygiene. It is important to remember that these cases were extremely unusual. Sensible precautions with bleeding wounds and cuts and not sharing personal hygiene items would have prevented these cases of infection.

There are also isolated cases of transmission from dental care workers to patients.

To date, there were three instances where transmission of HIV could only be tracked to the HIV-infected doctor, dentist or nurse treating the patient. At least one of these cases occurred prior to the implementation of strict equipment disinfection. However, the CDC reports that there has been one case of infection from healthcare worker to patient. That case involved a dentist.

Biting poses very little risk of HIV transmission. The possibility only exists if the person who is biting and the person who is bitten have an exchange of blood (such as through bleeding gums or open sores in the mouth.) Bites may transmit other infections, and should be treated immediately by thoroughly washing the bitten skin with soap and warm water, and disinfecting with antibiotic skin ointment.