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Risks Posed by HIV Infection

HIV is spread through consensual behavior. Accidental transinsular is a risk only in medical care settings or other situations were there can be contact with blood or bodily fluids. Infected patients pose a risk to their medical care providers. There is a much greater risk of death from workplace-acquired hepatitis B than from workplace-acquired HIV. The risk of transmission of HIV from health care providers to patients is just being explored. There is a risk of transmission during invasive procedures that must be considered. (See Chapter 23.) Except in certain medical care situations, it is HIV dementia and secondary infections, not HIV transmission, that endanger others.

HIV directly affects the central nervous system (CNS). This is independent of infections of the CNS that are secondary to immune system failure.[140] While originally thought to be a late sequella of AIDS, HIV CNS signs may be the first manifestation of the disease.[141] Central nervous system HIV infection may manifest as an acute encephalopathy within a few weeks of infection, or it may have a gradual course. It may affect all CNS functions, both motor and cognitive. Its symptoms include short-term memory loss, impaired motor function, and emotional disturbances.[142] This has profound implications for professionals such as physicians and pilots, and others, such as truck drivers, in whom mental impairment case endanger themselves and others.[143] (See Chapter 23.)

Secondary infections with conventional pathogens pose the only risk to the casual contacts of HIV carriers. Some cities have seen a substantial increase in new cases of tuberculosis because of a high prevalence of HIV infection. An HIV carrier infected with an easily communicated secondary infection poses the same risk to co-workers as any other person with the same communicable disease. There has already been documented spread of tuberculosis to health care workers in a clinic administering pentamidine to HIV-infected persons.[144] The potential spread of secondary infections by HIV carriers may be increased by the difficulty of controlling infections in immunosuppressed persons.

[140]Wilkie FL; Eisdorfer C; Morgan R; Loewenstein DA; Jose Szapocznik J: Cognition in early human immunodeficiency virus infection. Arch Neurol 1990; 47:433-40.

[141]Stern Y et al.: Multidisciplinary baseline assessment of homosexual men with and without human immunodeficiency virus infection; III. Neurologic and neuropsychological findings. Arch Gen Psychiatry 1991; 48:131-38.

[142]Lunn S; Skydsbjerg M; Schulsinger H; Parnas J; Pedersen C; Mathiesen L: A preliminary report on the neuropsychologic sequelae of human immunodeficiency virus. Arch Gen Psychiatry 1991; 48:139-42.

[143]Fulghum JS: Letter. JAMA 1990; 264:3147-48.

[144]CDC: Mycobacterium tuberculosis transmission in a health clinic--Florida 1988. MMWR 1989; 38:256-58, 263-64.

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