HIV Transmission Through Oral Sex May Be Common; Doctors Often Miss Early HIV Diagnosis

August 15, 1996

Good and Bad News in Battle Against AIDS
Good and Bad News in Fight Against AIDS

There is both good and bad news in the ongoing battle to stem the AIDS epidemic, a University of Washington study shows.

On the one hand, patients recently infected with the HIV virus reported they had far fewer sex partners in the months prior to infection, compared to people in similar circumstances a decade ago.

However, researchers found that among 46 patients who had acquired the virus since a recent earlier screening:
  • Acquisition of HIV infection occurs even among those with relatively few sexual partners;
  • Unprotected oral sex is the most common form of sexual contact among gay men who become HIV-infected;
  • Among people able to pinpoint the specific sexual contact that led to infection, oral sex was the possible route of transmission in some cases;
  • Seven percent of patients reported they had actively tried to acquire the HIV virus;
  • Even among patients who identified themselves at high risk for acquiring HIV and who went to their doctor with clinical symptoms at the time of transmission, only one-quarter were correctly diagnosed with acute HIV infection.
The study, undertaken to describe events that lead to HIV infection, was conducted by Dr. Timothy Schacker of the Virology Division of the UW Department of Medicine, and colleagues Dr. Lawrence Corey, Dr. Ann C. Collier, Dr. James Hughes and Theresa Shea. The study is reported in the Aug. 15 issue of The Annals of Internal Medicine.

Enrolled in the study were 43 men and three women who had acquired symptomatic HIV in the recent past, as documented by a negative screening test in the previous few months. All but one of the men reported sexual contact with other men as their principal risk behavior. (The three women reported heterosexual contact as their primary risk behavior.)

Four men reported only oral-genital contact. Schacker acknowledged that since his subjects were interviewed in person, they could have been less than candid. However, they were interviewed numerous times and their responses on sexual behaviors did not vary. The source partners of two of the four confirmed the descriptions of sexual activity.

The finding on oral-genital contact may be of special interest, notes Schacker, in light of a study reported June 7, 1996 in the journal Science by Dr. Ruth Ruprecht and colleagues at the Dana-Farber Cancer Institute in Boston, that showed an oral dose of semen from a rhesus monkey infected with the SIV (monkey AIDS) virus infected six of seven monkeys, even though their mouths were free of lesions.

"Despite warnings from health experts over the years, many advocacy groups have maintained that unprotected oral sex is a safe alternative to anal or genital intercourse," said Schacker. "The results of these and other studies show that oral sex may not be as safe as previously thought."

Unprotected oral-genital contact was the most commonly reported sexual activity. The subjects reported a median of 20 oral-genital contacts in the six months prior to acquiring HIV, versus two anal-genital contacts. Fewer than 4 percent of oral-genital contacts involved a barrier form of protection, while 42 percent of anal-genital contacts involved a condom.

Almost half the patients reported they had sexual contact with only one partner in the month before acquiring the virus, and a median of three partners in the six months infection. These figures show that a pattern of sequential monogamous relationships can lead to HIV infection, the researchers say.

Three men said they had intentionally engaged in unsafe sexual behavior to try to become infected with HIV, because they felt depressed and excluded from their peers, many of whom had AIDS.

In another finding, even among men undergoing routine screening for HIV at four- to six-month intervals (indicating they knew they were at risk), a correct diagnosis of acute HIV infection was made in only five of 19 patients who went to their doctor with symptoms.

"The symptoms may make it difficult to differentiate from other illnesses," said Schacker. "Many patients go to one clinic for anonymous HIV testing, and to another for routine medical care. The caregiver may be ignorant of a patient's risk factors for HIV and thus not recognize or correctly diagnose symptoms.

"Health care providers need to maintain a high index of suspicion for symptoms suggestive of primary HIV," said Schacker, adding that an adequate sexual contact history should be taken when sexually active patients visit emergency rooms or clinics with fevers, sore throats or symptoms of mononucleosis or viral meningitis. "We recommend testing with a P24 antigen or HIV RNA and HIV antibody test in all high-risk patients who have symptoms compatible with acute HIV infection."

The researchers add that diagnosing recently acquired HIV infection may be important for several reasons. In the first few weeks after infection, the amount of virus in the blood (and presumably semen) is the highest it will ever be, which may make it easier to transmit the infection to others. Transmission of the virus in the period even before diagnosis was documented in several patients.

Early diagnosis can also facilitate rapid initiation of treatment, which becomes increasingly important as new therapies are developed.

The researchers give several caveats about the study. Subjects were referred to the UW research clinic conducting the study, and thus were more likely to have symptoms. It involved mostly men who acquired HIV through sexual contact, so results cannot be generalized to the entire population of HIV-infected persons. The study also does not provide insight into how HIV is acquired in women or through intravenous drug use.

University of Washington

Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to