[Question #411] Inhaling HIV infected smoke?

34 months ago
There is not much literature on if inhaling possibly infected smoke is risky. Recently, I smoked a hookah with a friend. My friend happens to be a Libyan doctor. Before we started smoking, I jokingly asked him if he was a virgin. I said that otherwise I didn't want to catch a disease. He laughed and told me he was a virgin and that anyway, I couldn't catch anything from the hookah. We both had separate mouth pieces. However, I know that even if a small amount of blood may have gotten on mine, it is not likely to get HIV that way. My question arises to inhaling smoke that was possibly infected. I just can't get this idea out of my mind that when I went to the bathroom, he may have put blood in the hookah water or spit blood inside the hose as disrespect for me asking him if he was a virgin.  As you know, like a bong, smoke from the hookah will pass through water and the hookah smoke is sort of a water vapor. If he put blood in the water and I inhaled this infected water vapor, is there a chance I could become infected? I'm also worried about this guy being a doctor who previously worked out in Libya. Libya is in Africa and although it's not a a country largely affected by HIV, I'm atu. I know it's not a big HIV infected country, so it's doubtful this man I smoked with was infected, but I was reading of a case in the late 90s where 400 children were infected with the virus. The Libyan government claimed two Bulgarian nurses intentionally did it, while the nurses claimed there were unsanitary conditions in the hospital. I'm sure this  was a highly publicized case in Libya and maybe this gave the guy an idea to infect the hookah if indeed he does have HIV. Am I just being super paranoid? In the insane event that infected blood got into the hookah water (where the smoke would pass through) or in the hose where the smoke would go up and I inhaled infected smoke (keep in mind hookah smoke is moist like water vapor) is there a chance I could become infected? I'm so worried. 
34 months ago
Forgive me for the typos and cut off sentences, but the box froze while I was trying to edit my question :) I wish I could stop worrying about this stuff. Last month, I wrote in to ask about possible blood from a worker on food. Ive been so paranoid and careful because in November, I tested negative and now I want to be soooooo cautious not to potentially expose myself to anything. I'm a bit ashamed to keep calling hotlines or constantly bother my physician with these worries, so here I am posting a second time :( 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Welcome to the forum. You were cut off because there is a limit of 2,000 characters (about 400 words) for new questions. As described on the forum home page, normally questions that exceed that limit and continue into a follow-up window are deleted without reply. But you didn't go that much over the limit and I guess I'm feeling generous!

HIV has never been known to be acquired by inhaling it, or by sharing inhaled drug equipment like hookahs. It's also not transmitted by shared cigarets -- and generally not by any oral exposure to the virus. Could I imagine a theoretical transmission scenario if blood somehow got into a hookah? Sure. Is it likely to ever happen? No. Is it likely to have happned to you? Of course not. I suggest you entirely ignore the biological reasons why it might or might not happen.

And I also would point out that from all you say, it sounds extremely unlikely your hookah sharing buddy has HIV. But even if he did, you shouldn't be worried.

I hope this has been helpful. Best wishes--  HHH, MD

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34 months ago
I know it's not easily transmitted orally by saliva, but can it be transmitted if blood were on the tobacco or inside the hose or in the water and I inhaled the blood in a sort of vaporized form? Would you recommend Pep? 
34 months ago
Basically if smoke mixed with HIV blood gets into your lungs via hookah water pipe? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
You are re-asking the same questions in different words. I already said that even if blood were to get inside the hookah (including hose, water, etc) there probably would be no risk of HIV. And how would such blood contamination happen anyway? I also said that oral exposure almost never results in HIV transmission -- which tells you that blood on a cigaratet would be little if any risk.

Abnormal pap smears result from HPV, not HIV. That requires vaginal exposure to HPV. You can't catch HIV, HPV, or any STD orally and have it show up in the genital area. So of course this event does not require any other STD testing, including pap smear.


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34 months ago
Sorry, I dont believe I mentioned anything about a papsmear. Maybe my question was confused with somebody else. I asked if you recommend I take PEP or PREP? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Oops -- sorry -- I had just replied to a different question that had a pap smear component. Apology for any confusion.

You definitely do not need PEP after this event. It would be a big mistake (the risk of a serious side effect from the PEP drugs is far higher than the chance you caught HIV). I doubt you could find any doctor or clinic willing to prescribe it anyway.

Please understand this going forward:  To avoid HIV your entire life, know your sex partners; have safe sex with any new or high risk partners; and do not share drug injection equipment with anyone. That's all. Beyond those things, you should never lose a wink of sleep worrying about HIV.

That completes the allowance for two follow-up comments and replies, and so ends this thread. Do your best to go on with your life without worry about the hookah business.


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