References:

[1] CDC Options project: AIDS 1999;16:737-8

[2] Dillon, et al: reporting on the CDC's Options Project at the 7th Conference on Retroviruses and Opportunistic Infections; San Francisco; 2000; Abstract 473

[3] Merchant RC: Nonoccupational HIV postexposure prophylaxis: a new role for the emergency department.  Ann Emerg Med; 01-Oct-2000; 36(4): 366-75

[4] Scully C, Porter S. HIV topic update: oro-genital transmission of HIV. Oral Dis 2000;6:92-8.

[5] Department of Health. Review of the evidence on risk of HIV
transmission associated with oral sex. Report of a Working Group of the UK Chief Medical Officers' Expert Advisory Group on AIDS. 2000.

[6]Belec L. Transmission sexuelle du Sida. Que sais-je, France: Presse Universitaire de France; 2001.

[7]  Rotherberg RB, Scarlett M, del Rio C, Reznik D, O'Daniels C. Oral transmission of HIV. AIDS 1998;12:2095-105

[8] Cited in Sex Transm Infect 2001;77(5):307-8)

[9] Merchant, supra.
[...There are no clearly accepted indications for PEP after nonoccupational HIV exposures...]

[10] Downs AM, de Vincenzi I. Probability of heterosexual transmission of HIV: relationship to the number of unprotected sexual contacts. J Acquir Immune Defic Syndr Hum Retrovirol. 1996;11:388-395
[...0.5 to 1.5 in 1000 risk for receptive vaginal intercourse per sexual contact...no data on oral oral route...]

[11] DeGruttola V, Seage GR III, Mayer KH, et al. Infectiousness of HIV between male homosexual partners. J Clin Epidemiol. 1989;42:849-856.
[...5 to 30 per 1000 risk of seroconversion for unprotected receptive anal intercourse per sexual contact...no data on oral route...]

[12] Gerberding JL. Prophylaxis for occupational exposure to HIV. Ann Intern Med. 1996;125:497-501
[...3.2 in 1000 risk of seroconversion with needle stick injuries...no data on oral route...]

[13] Scully C, Porter S. HIV topic update: oro-genital transmission of HIV. Oral Dis 2000;6:92-8

[14] Department of Health. Review of the evidence on risk of HIV
transmission associated with oral sex. Report of a Working Group of the UK Chief Medical Officers' Expert Advisory Group on AIDS. 2000

[15] Belec L. Transmission sexuelle du Sida. Que sais-je, France: Presse Universitaire de France; 2001

Citations 13-15 conclude the following:
[...Several viruses, including the human immunodeficiency virus (HIV), can be found in blood and many body fluids including saliva, and are transmissible sexually across genital and particularly anal mucosae. A persisting concern has been the question of transmission of HIV by oral sexual practices. This review discusses the evidence for oro-genital transmission of HIV, detailing the presence and infectivity of HIV in genital fluids and saliva, the case reports and epidemiology of oro-genital HIV transmission, and the evidence from animal studies. Oral intercourse is not risk-free. The evidence suggests that the risk of HIV transmission from oro-genital sexual practices is substantially lower than that from penile-vaginal or penile-anal intercourse, that exposure to saliva presents a considerably lower risk than exposure to semen, and that oral
trauma and ulcerative conditions might increase the risk of HIV transmission...]

[16] Henderson DK, et al: Risk for occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures. A prospective evaluation [see comments]. Ann Intern Med 1990 Nov 15;113(10):740-6
[...CONCLUSIONS: Combining our results with those of other prospective studies, the risk for HIV-1 transmission associated with a percutaneous exposure to blood from an HIV-1-infected patient is approximately 0.3% per exposure (95% CI, 0.13% to 0.70%); the risks associated with occupational mucous membrane and cutaneous exposures are likely to be substantially smaller....]

[17] Varghese B: Reducing the risk of sexual HIV transmission: quantifying the per-actrisk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis; 01-Jan-2002; 29(1): 38-43
[...RESULTS: Choosing a partner who tested negative instead of an untested partner reduced the relative risk of HIV infection 47-fold; using condoms, 20-fold; and choosing insertive fellatio rather than insertive anal sex, 13-fold. Choosing one risk-reduction behavior substantially reduces absolute risk of HIV infection for heterosexuals but not for men who have sex with men. CONCLUSION: Clarifying the magnitude of risk
associated with different choices may help people make effective and sustainable changes in behavior...]

[18] Bartlett, JG: Prophylaxis following body fluid exposure from HIV-infected patients. UptoDate.com (June 2003)
[...The risk of becoming infected with HIV-1 after exposure to body fluids from an HIV-infected patient is extremely low. A review of 23 studies of needlestick injuries to HCW exposed to an HIV-infected source in the era before the introduction of highly active antiretroviral therapy (HAART) noted the following findings: HIV transmission occurred in 20 of 6135
cases (0.33 percent) (Only) one case of HIV-1 was transmitted out of 1143 exposures (0.09 percent) on the mucosa of the healthcare worker...]

[19] del Romero J,Marinocovich B, Castilla J et al. Evaluating the risk of HIV transmission through unprotected orogential sex. AIDS 2002;16:1296-97.

[20] Page-Shafer K, et al: Risk of HIV infection attributable to oral sex among men who have sex with men and in the population of men who have sex with men. AIDS 2002;16:2350-52

[21] http://www.feminist.org/news/newsbyte/uswirestory.asp?id=7364 political agenda & women's issues

-- Modified on 6/8/2003 12:13:15 PM