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Can I get HIV from scratching my face with dirty fingernails?

September 29, 2009

Question

I am very worried. Many times I scratch my face due to my pimples, and also many times I bleed because I scratch too much. I need to know, if I touch fresh blood or any fresh HIV infectious fluids with my fingers and some of this blood or fluids are accumulated in my fingernails, and the I scratch my face and I also bleed, do I have risk of getting HIV? What about if these fluids are already dry, will I still have chance of getting HIV infected?

Answer

First of all, it sounds like you are going to scar your face if you keep scratching your pimples. Wash your hands and face with mild but antibacterial soap. Try not to scratch since this will only make the acne worse.

Second, if you are in a situation where you are coming into contact with fresh blood then you should be wearing gloves anyway. You don't describe what situations might expose you to blood.

HIV is not transmitted through casual contact with other people. Infectious blood can only infect broken skin. Theoretically, the answer to your question is "yes," however Hepatitis B and C are much more easily transmitted through blood contact than HIV since Hepatitis appears to be able to remain viable outside the body for longer than HIV.

So the question is, are you actually touching other people's blood? If so, then you need to wear protection. Either way you should wash your hands more frequently and address the scratching problem before you cause any more permanent scarring.


Tags: pimples, scratch, fingernail, acne

Lack of transmission of HIV through human bites and scratches.

September 25, 2009

To examine the relative risk of transmission of the human immuno-deficiency virus (HIV) through bites and scratches, we studied 198 health care workers, 30 of whom were traumatized in this fashion while caring for an aggressive AIDS patient.

This violent patient frequently bit or scratched others, his mouth had blood and saliva, while his fingernails were at times soiled with semen, feces, and urine. He was HIV antibody and antigen positive. Although HIV was recovered from his peripheral blood lymphocytes, after 2.5 years of serial follow-up, all traumatized personnel were clinically normal, no HIV was cultured from their blood, and all were HIV antibody and P24 antigen negative.

We conclude that this viremic AIDS patient, while producing copious amounts of body fluids, failed to infect those caring for him through bites and scratches. The risk of transmission of HIV through this route under similar conditions should be low.

Sources : Division of Clinical Immunology, Montreal General Hospital, Canada.


Tags: pimples, scratch, fingernail, acne

HIV Medication

September 20, 2009

Current treatments prevent the virus from replicating in the body. This in turn reduces the amount of virus in the blood and allows the immune system to recover. To achieve this, three antiretroviral medicines are usually taken together. They normally have to be taken once a day but some need to be taken up to three times a day and at specific times. This combination therapy is termed highly active antiretroviral therapy (HAART) and has dramatically cut the number of deaths from AIDS-related illnesses since its introduction. There are three main classes of antiretroviral medicine. Combination therapies usually contain medicines from two of these classes.

Nucleoside reverse transcriptase inhibitors (NRTIs)
NRTIs prevent HIV from copying its genetic information and so multiplying. They include abacavir (eg Ziagen), lamivudine (eg Zeffix) and zidovudine (eg Retrovir).

Protease inhibitors (PIs)
PIs prevent the virus from assembling its protective coat before leaving CD4 cells. Ritonavir boosted protease inhibitors may be used to increase the potency of the medicine. They include atazanavir (eg Reyataz) and saquinavir (eg Invirase).

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
NNRTIs are a highly effective class of antiretrovirals, which have a similar mode of action to NRTIs. They include efavirenz (eg Sustiva) and nevirapine (eg Viramune).

HIV fusion-inhibitor
An HIV fusion-inhibitor is a medicine used in combination with other medicines when the infection is no longer controlled by other treatments. There is just one fusion-inhibitor, enfuvirtide (Fuzeon).

Potential new treatments
In the future, further anti-HIV medicines may be produced. These may include medicines that stimulate the patient's own immune system to fight off HIV or target the virus in different ways. Integrase inhibitors are a new class of medicine being developed. One example is raltegravir, which is currently in human trials and is showing promise.

CCR5 inhibitors are also in development, one of which is maraviroc and studies of these medicines are continuing.

Second generation NNRTs such as etravirine have recently been developed but are not widely available yet.

There are also hopes that a cure for HIV infection and a vaccine to prevent infection will be developed.

Side-effects
The combination treatment can cause side-effects. In the first few months, you may feel sick, vomit and have a headache, although these often wear off. Some medicines can cause sleep disturbances or depression. PIs and NRTIs are associated with a syndrome called lipodystrophy, which involves a thinning of the face, arms, legs and buttocks, and a build-up of fat on the belly, breasts and back. The redistribution of fat can be managed, for example, by changing the combination treatment and changing your diet and exercise. Lipodystrophy, caused by PIs, can also increase the risk of heart disease.


Tags: pimples, scratch, fingernail, acne

HIV patients at greater risk for bone fractures

September 15, 2009


"Prior studies have indicated reduced bone density in HIV-infected patients, but little was known whether fracture risk increased in this population," said Dr. Steven Grinspoon, M.D., of Massachusetts General Hospital in Boston and lead author of the study. "These data are the first to suggest that there is a clinically significant increase in bone fractures among HIV-infected patients, using data from a large healthcare system."

In this study, researchers analyzed data from the Partners HealthCare System, which includes two primary hospitals, Brigham and Women's Hospital and Massachusetts General Hospital. They studied fracture diagnoses from 1996 to 2008 in 8,525 HIV-infected patients and more than 2 million non HIV-infected patients. Dr. Grinspoon and his colleagues found that overall fracture prevalence increased more than 60 percent in HIV-infected patients versus non HIV-infected patients.

The data in this study showed HIV-infected patients had a significantly higher prevalence of vertebral, hip, wrist, and combined fractures compare to non HIV-infected patients. Within both sexes, fracture prevalence was higher in HIV-infected patients for the majority of sites assessed, across age categories.

Dr. Grinspoon said the study found the relative difference in fracture prevalence between HIV-infected patients and non HIV-infected patients increases with age for both sexes. Therefore, as the HIV-infected population ages, reduced bone mineral density and increased fracture risk may become an even greater problem.

"HIV patients with risk for low bone density should be assessed and potentially treated to prevent fractures," said Dr. Grinspoon. "Further research is needed into the mechanisms of bone loss in this population."

Source: The Endocrine Society



Tags: pimples, scratch, fingernail, acne

Observational Studies of Non-Occupational Post Exposure Prophylaxis (nPEP)

September 08, 2009

The most direct evidence supporting the efficacy of postexposure prophylaxis is a case-control study of needlestick injuries to health-care workers. In this study, the prompt initiation of zidovudine was associated with an 81% decrease in the risk for acquiring HIV. Although analogous clinical studies of nPEP have not been conducted, data are
available from observational studies and registries.

Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997;337:1485--90.

Although analogous clinical studies of nPEP have not been conducted, data are available from observational studies and registries. In a high-risk HIV incidence cohort in Brazil, nPEP instruction and 4-day starter packs of zidovudine and lamivudine were administered to 200 homosexual and bisexual men. Men who began taking nPEP after a self-identified high-risk exposure were evaluated within 96 hours; 92% met the event eligibility criteria (clinician-defined high-risk exposure). Seroincidence was 0.7 per 100 person-years (one seroconversion) among men who took nPEP and 4.1 per 100 personyears among men who did not take nPEP (11 seroconversions). Subsequent analysis of data from patients who took nPEP and had been followed for a median of 24.2 months indicated 11 seroconversions and a seroincidence of 2.9 per 100 person-years, compared with an expected seroincidence of 3.1 per 100 person years, p>0.97).

In a study of sexual assault survivors in Sao Paolo, Brazil, women who sought care within 72 hours after exposure were treated for 28 days with either zidovudine and lamivudine (for those without mucosal trauma) or zidovudine, lamivudine, and indinavir (for those with mucosal trauma or those subjected to unprotected anal sex) for 28 days. Women were not treated if they sought care >72 hours after assault, if the assailant was HIV-negative, or if a condom was used and no mucosal trauma was seen. Of 180 women treated, none seroconverted. Of 145 women not treated, four (2.7%) seroconverted. Although these studies demonstrate that nPEP might reduce the risk for infection after sexual HIV exposures, participants were not randomly assigned, and sample sizes were too small for statistically significant conclusions.

In a study of rape survivors in South Africa, of 480 initially seronegative survivors begun on zidovudine and lamivudine and followed up for at least 6 weeks, one woman seroconverted. She had started taking medications 96 hours after the assault. An additional woman, who sought treatment 12 days after assault, was seronegative at that time but not offered nPEP. At retesting 6 weeks after the assault, she had seroconverted and had a positive polymerase chain reaction result (Personal communication, A. Wulfsohn, MD, Sunninghill Hospital, Gauteng, South Africa).

In a feasibility trial of nPEP conducted in San Francisco, 401 persons with eligible sexual and injection-drug--use exposures were enrolled. No seroconversions were observed among those who completed treatment, those who interrupted treatment, or those who did not receive nPEP.

In a study in British Columbia of 590 persons who completed a course of nPEP, no seroconversions were observed.

In registries from four countries (Australia, France, Switzerland, and the United States), including approximately 2,000 nonoccupational exposure case reports, no confirmed seroconversions have been attributed to a failure of nPEP in approximately 350 nPEP-treated persons reported to have been exposed to HIV-infected sources. However, the absence of seroconversions might not be attributed to receipt of nPEP but rather to the low per-act risk for infection and incomplete follow-up in the registries.


Tags: pimples, scratch, fingernail, acne

Antiretroviral Side Effects and Toxicity

September 02, 2009

Initial concerns about severe side effects and toxicities have been ameliorated by experience with health-care workerswho have taken PEP after occupational exposures. Of 492 health-care workers reported to the occupational PEP registry, 63% took at least three medications.

Overall, 76% of workers who received PEP and had 6 weeks of follow-up reported certain symptoms (i.e., nausea [57%] and fatigue or malaise [38%]). Only 8% of these workers had laboratory abnormalities, few of which were serious and all of which resolved promptly at the end of antiretroviral treatment. Six (1.3%) reported severe adverse events, and four stopped taking PEP because of them. Of 68 workers who stopped taking PEP despite exposure to a source person known to be HIV-positive, 29 (43%) stopped because of side effects.


Tags: pimples, scratch, fingernail, acne


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