[Question #2053] HIV1 and HIV2

47 months ago

Greetings Doctor,

I have five questions. Most of my questions are about the differences between HIV1 and HIV2.

(1): Is the risk of transmission for HIV1 and HIV2 the same? I have read that the transmission risk from a needle stick of a needle infected with HIV1 is one in three hundred. Does this mean that the transmission risk from a needle stick of a needle infected with HIV2 is also one in three hundred?

(2): I read that HIV1 his very fragile and dies quickly in the environment. Is this also the case for HIV2? Does this mean that environmental transmission risk  of HIV2 would be the same as environmental risk for HIV1. Phrased differently: is environmental transmission zero risk for all realistic purposes for both HIV1 and HIV2?

(3): From what I gather, HIV1 can be well controlled with treatment and someone infected with HIV1 can expect to live a relatively long, normal life. Is the same true about treatment and life expectancy for someone with HIV2?

(4): I work in a place that works frequently with immigrants from Africa where HIV2 is more common. How common is it? Would many immigrants likely have HIV2? Do I need to be concerned about a risk in my workplace?

(5): Would any needlestick that puts me at risk be obvious to me? Would I likely notice bleeding and a needle sticking out of me? Or could a needlestick just scrape or poke me and put me at risk without my being aware of it?

Many thanks

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
Welcome to the forum. Thanks for your question.

Before I address your specific questions, you should also understand that HIV2 is virtually absent in the US and other industrialized countries. Although a few cases have been detected, most have been in people who acquired the infection in the part of West Africa where it evolved (e.g. Camaroon) but were diagnosed after moving; and very rare cases in the sex partners of such persons. Even if HIV2 were not covered in the current HIV blood tests in common use (it is), there would be little risk of missing an infection or ongoing transmission.

As for your questions, be aware these are my best judgment. However, there has not been conclusive research on some of these issues.

1) There is no evidence of any difference in transmission risk between HIV1 and 2 for particular exposures of any type. FYI, the 1 in 300 risk for HIV for needlestick applies only for health professionals injured with sharp instruments that had just been used on HIV infected persons. The risk from needlestick outside heatlh care settings, e.g. from an accidental prick with a used hypodermic needle in the environment, is far smaller, Few such infections have ever been documented.

2) As far as known, HIV@ is equally fragile and no more likely to persist in the environment that HIV1, or to carry any risk of transmission from environmental exposure.

3) Even without treatment, HIV2 is less agressive than HIV1, i.e. more infected persons do not develop serious immunodeficiency and life expetency is significantly longer. To my knowledge, HIV2 responds equally well as HIV1 to current treatment regimens. (The regimen of choice -- i.e. the specific drugs and their dosages -- might vary compared with HIV1. But equally effective regimens are available.)

4) Few immigrants from Africa have HIV. And as implied above, Africa in general is not a high-risk area in regard to HIV2. In any case, nobody ever should be worried about HIV because they work with immigrants from Africa or anywhere else. There is no such thing as workplace transmission of HIV, except rarely among health care providers.

5) Yes, any needlestick injury that might transmit HIV would be obvious at the time of injury. That is, any needle injury too minor to notice would carry little or no risk.

Best regards--  HHH, MD

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47 months ago
Thank you doctor.  Another question I have is whether or not the location of a needle stick makes any difference to the 1 in 300 average risk. For example, would a needle stick on my face be a higher risk than a needle stick on my hand or foot? I am guessing not, and I understand there may not be data on this, but I was wondering if your knowledge of the virus would lead you to believe anything about this. Thanks
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
True there are no data on this, i.e. no evidence that location of a needlestick or other sharp instrument injury would make any difference in likelihood of HIV transmisison. And also no biological reason to suppose this would make a difference.
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47 months ago

Dr. Handsfield,

Thank you for your answers. Also, thank you for allowing me a chance to ask some follow up questions, it is a very nice feature of this help forum. I reviewed the forum guidelines and I understand I can post one final follow up response.

I have two questions:

1. Does my oral HSV-1 (oral herpes//cold sores) make any difference to my chances of contracting HIV via needle stick or other form of non-sexual exposure? Does any other medical condition that you are aware of?

2. While at the bank today there was some small pools of liquid on the counter. The liquid was in small pools but still wet. I didn’t think anything of it until I noticed that a twenty dollar bill in my wallet had a red stain at the top. I wondered maybe this was a red stain from the liquid, meaning the liquid might have been blood. I was concerned maybe I came into contact with this blood, such as this blood contacting my arm or hand, and then this blood got into my body when I rubbed my eyes or picked the inside of my nose or put my hands into my mouth. Further, what if I contacted this blood and then touched another type of skin sore I have, such as pimples on my face or arms? Is this sort of transmission route a concern?

47 months ago
Oh yes, one more clarification, I did have some minor scrapes on my hands and arms. Would this put me at risk from the liquid at the bank?

Thanks
47 months ago
Sorry, I just wanted to be clear about one thing: some of the scrapes on my hand were from when I scraped myself on some stuff in my pocket while I was at the bank counter. I hope this doesnt change your opinion of my risk, which I'm hoping isnt big. This is my last comment. Thank you again for everything.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
47 months ago
1) HSV1 has no apparent effect on HIV acquistion risk. HSV2 increases the risk of HIV if sexually exposed.

2) No risk at all. Although "blood contact" is routinely listed as a risk for HIV, it's really just a theoretical issue. Nobody anywhere in the world has ever been reported to have actually caught HIV from any kind of environmental exposure, or even from caring for persons who are bleeding, like helping out after an auto wreck. You can ignore and disregard this and any futhrer contacts with liquids in the environment, money, or personal contact with other people other than sexual or needle sharing. If you are not at sexual risk and do not share drug injection equipment with other people, you will never be at risk. Ignore (and thus no need ever to ask again about) things like HIV infected coworkers, exchanging money (with or without "red stains"), or other day to day personal contacts with other persons. Please believe it -- and refrain from further questons along these lines.

Thanks for the thanks. Take care. And stop worrying about such things!

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