HIV/AIDS: An Update ________________________________________________________________________
lence of HIV infection. This may in part be attributed to the exchange of cocaine for sex. Sharing of equipment is common due to legal and financial restrictions and cultural norms, and some studies have linked higher levels of psychologic distress (e.g., anxiety and depressive symptoms) with an increased risk for needle sharing [22]. Secondary transmission occurs to children and sexual partners. Preventative strategies include medication-assisted drug treatment, onsite medical care in a drug treatment program, recruitment of “street” outreach workers for intensive drug and sex risk-reduction educational campaigns, teaching addicts to sterilize their equipment between use, the free provision or exchange of sterile injec- tion equipment (as allowed by law), distribution of condoms and bleach to clean drug use equipment, or a combination of these interventions. Perinatal Transmission In the absence of prophylactic treatment, approximately 15% to 45% of children born to HIV-infected mothers will contract HIV infection; this increases to 50% with prolonged breast- feeding [32]. HIV is transmitted to infants by transplacental spread from mother to fetus in utero, during parturition, or through breastfeeding after birth. Because infants have under- developed natural resistance systems, they are highly susceptible to many infections, including HIV. Transmission usually occurs during labor and delivery and the early breastfeeding stage [33]. Worldwide, perinatal transmission accounts for most HIV infections among children. In the United States, perinatal transmission has been markedly decreased, by more than 95%, since the mid-1990s; in 2019, there were 3,540 hospital-based live births among persons with an HIV diagnosis, of which 32 infants were diagnosed with perinatally acquired HIV [33]. Studies have shown that treating pregnant and breastfeeding women with antiretroviral therapy (ART) to achieve viral sup- pression results in a <1% infection rate of HIV transmitted mother-to-infant [32; 34]. The American Academy of Pediatrics recommends that for people with HIV in the United States, avoidance of breastfeeding is the only infant feeding option with 0% risk of HIV transmission; however, if an individual with HIV expresses an interest to breastfeed, a family-centered, nonjudgmental, harm-reduction approach to support the indi- vidual, including ensuring ART with sustained viral suppres- sion less than 50 copies/mL, should be employed. Patients with HIV who are considering breastfeeding and are not on ART, or are on ART without viral suppression, should be advised not to breastfeed [41]. Standard screening of all pregnant women is necessary to reduce transmission of HIV to infants. Organ Transplantation Because these procedures are less common than other trans- mission-related activities, there have been very few case reports of HIV acquisition by this route. HIV has been transmitted via transplanted kidneys, liver, heart, pancreas, bone, and, pos- sibly, skin grafts and through artificial insemination. HIV test- ing is used in these circumstances to rule out infection. Most
cases of transmission through transplants of organs, bone, or tissue occurred before HIV screening was available. However, in 2007, four organ transplant recipients contracted HIV and hepatitis C from a single organ donor, and in 2009, HIV was transmitted by a living kidney donor [36; 37]. These were the first cases of HIV infection resulting from transplantation since 1985. Though the donors were tested for HIV and hepatitis, the tests resulted in false negatives. As with blood transfu- sions, donors testing antibody seronegative may pass HIV infection on to recipients. The use of nucleic acid testing and reconsideration of the use of high-risk donors have both been recommended to ensure the safety of donor recipients [36]. Cosmetic Procedures In 2018, the CDC began investigating a spa in New Mexico, after a woman was diagnosed positive for HIV in connection to a micro-needling facial treatment. The woman received a “platelet-rich plasma” (PRP) with microneedling procedure (i.e., vampire facial) that involves drawing blood from the client, separating the blood into its components of plasma and cells, and using single-use disposable or multiuse sterile equipment (microneedles) to inject PRP in specific areas of the face, with the goal of skin rejuvenation and reduced appearance of scars [31]. Within months of the treatment, the woman received a positive HIV diagnosis, marking the first case of transmission by a nonsterile cosmetic injection procedure. As of 2023, five people were found to have been diagnosed positive with HIV in relation to the PRP facial at the spa; four women who directly received the procedure at least once, and one male who was a sexual partner of one of the directly infected women. In the investigation, the CDC found several violations and examples of unsafe infection control practices in the spa, highlighting the need for adherence to established infection control practices and public education for consumers of these services to be aware of the risks [27; 31]. Occupational Exposures Transmission due to occupational exposure of healthcare work- ers has occurred in needlestick accidents and blood splashes to the mucous membranes. Needlestick is the most common route. Thousands of healthcare personnel who were so exposed have been studied, and only 58 cases of well-documented infec- tion have been reported in the United States (24 of which were nurses), and only one case has been reported since 2008 [38]. The risk of infection through this route is low, and every effort should be made to decrease the exposure rate. Educational efforts, implementation of engineering controls in needled and sharp-edged medical devices, the use of hard plastic needle disposal units where these devices are most frequently used, and the development of procedural details to avoid blood and body fluid contact have greatly reduced the exposure rate. Healthcare personnel should apply Universal Precautions, as discussed in the Occupational Safety and Health Administra- tion (OSHA) Bloodborne Pathogens standard regulations, to all activities to avoid contact with human fluids [27].
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MDCT2026
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