Abstract:

Background Most new HIV infections are acquired from stable, long‐term partners. HIV serodiscordant relationships are among the most vulnerable to acquiring???? It is not uncommon getting exposed to body fluids of an HIV infected partner in a serodiscordant (magnetic couples) set ups. This is an interesting case scenario cutting across many issues about the transmissibility of HIV infection in. There may be queries from apprehensive people – seeking advice reg?? HIV’s probability of acquisition under some very uncommon conditions which may be helpful for training/teaching purposes

Objectives The scenario (A non‐HIV Patient getting exposed to semen of a HIV positive man with an undetectable viral load –VL at the hand having an open cut) is an interesting, educative and unique case scenario as it involves almost all issues related to HIV prevention i.e. scanty information ‐‐withholding his/her name and gender possibly due to stigma/discrimination issues forwarded by the questioner and issues involving responses to various situations in serodiscordant couples (‘magnetic couples ‘) exposure in an unique non‐occupational yet non‐sexual mode, counseling& testing issues, initiating nPEP (Non‐occupational Post Exposure Prophylaxis) and PrEP (Pre‐Exposure Prophylaxis), TasP (Treatment as Prevention) and HTPN 052 Study. The importance of answering this kind of scenarios lies in the fact that it would help many‐‐including the questioner itself.

Methods Descriptive study discussing the different aspects of HIV Prevention.

Results The questioner’s HIV‐acquisition risks are extremely low (theoretically) & unwarranted still we will try to put his/her fears to rest by examining the issues involved in this case critically and coming up with scientifically based explanations and accordingly advice him/her taking into the considerations of HIV Testing and Treatment policies and Guidelines of the land available.

Conclusions This scenario is a very interesting one, requiring many basic concepts of prevention of HIV/AIDS for answering and may be used for teaching/training even medical professionals. The questioner’s HIV‐acquisition risks are extremely low (theoretically) & unwarranted and we will try to put his/her fears to rest by examining the issues involved in this case critically and coming up with scientifically based explanations and accordingly advice him/her taking into the considerations of HIV Testing and Treatment Policies and Guidelines of the land available. The importance of answering this kind of scenarios lies in the fact that it would help other health professionals and questioners alike and may be useful in teaching/training settings.

References:

[1]. ART PEP after sexual, injection drug use or other non‐occupational exposure to HIV in US,MMWR – Recommendations and Report 2005, 54: 1‐20

[2]. CDC Guidelines for PrEP for MSM and heterosexual couples where one partner in infected with HIV, Smith et al MMWR 2012, 61: 588‐589

[3]. CD4 Counts and Viral Loads of Newly Diagnosed HIV‐Infected Individuals: Implications for Treatment as Prevention: Sarishen Govender, et al http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0090754 Accessed on 20^th.Oct 2015

[4]. Chemaitelly H et al. Distinct HIV discordancy patterns by epidemic size in stable sexual partnerships in sub‐Saharan Africa.

[5]. Demographic and Health Survey (DHS) 2000–2010. http://www.measuredhs.com/surveys/dhs/start.cfm

[6]. Effect of ART on the sheading of in seman, Vernazetal: AIDS: 1997 – 11: 1249‐1254.

[7]. EyawoO et al. HIV status in discordant couples in sub‐Saharan Africa: a systematic review and meta‐analysis. The Lancet infectious Diseases, 2011, 11(4):263–264.

[8]. Guidance on couples HiV Testing and counseling including anti‐retroViral Therapy for Treatment and prevention in serodiscordant couples Recommendations for a public health approach, April 2012, WHO

[9]. HAART does not completely suppress HIV in semen in sexually active HIV infected MSM, Politch JA et al, AIDS: 2012, 26: 1535‐1543

[10]. HIV and its Transmission sheet: http://www.cdc.gov/hiv/pubs/facts/transmission.htm.

[11]. Lingappa JR et al. Regional differences in prevalence of HIV‐1 discordance in Africa and enrollment of HIV‐1 discordant couples into an HIV‐1 prevention trial. PLoS One, 2008, 3(1):e1411.

[12]. Non‐occupational post exposure prophylaxis for HIV: a systematic review, J Bryant, L Baxter and S Hird Health Technology Assessment 2009; Vol. 13: 1‐82

[13]. Persistence of HIVRNA in semen despite Effective ART, Sheth P M et al: AIDS: 2009‐23 = 2050‐2054

[14]. Prevention of HIV ‐1 Infection with early ART Cohen et al, NEJM 2011, 365: 493‐505

[15]. Reduction of seminal shedding in receiving HAART: A 18 month longitudinal studies, Leruez – villa M et al: AIDS 2002 ‐16: 456‐488

[16]. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health‐Care Settings (MMWR September 22, 2006 / 55(RR14);1‐17)

[17]. Sexually Transmitted Infections, 2012, 88:51–57. De Walque D. Sero‐discordant couples in five African countries: Implications for prevention strategies.

[18]. Understanding HIV Transmission Risk in Married, HIV Serodiscordant Couples in Gujarat, India: The Positive JeevanSathi Study By: Shilpa N. Patel http://www.cfar.emory.edu/downloads/news/DissAbstract_Patel.pdf

[19]. Vital Signs: HIV Prevention through Care and Treatment, Cohen et al US MMWR‐2011 60: 1618‐1623

[20]. VL and Hetero sexual transmission of HIV ‐1, Quinn et al, NEJM, 2000: 342: 921‐929