Current Trends Additional Recommendations to Reduce Sexual and Drug
Abuse-Related Transmission of Human T-Lymphotropic Virus Type III/
Human T-lymphotropic virus type III/lymphadenopathy-associated
(HTLV-III/LAV), the virus that causes acquired immunodeficiency
(AIDS), is transmitted through sexual contact, parenteral exposure
infected blood or blood components, and perinatally from mother to
neonate. In the United States, over 73% of adult AIDS patients are
homosexual or bisexual men; 11% of these males also had a history
intravenous (IV) drug abuse. Seventeen percent of all adult AIDS
were heterosexual men or women who abused IV drugs (1,2). The
HTLV-III/LAV antibody is high in certain risk groups in the United
Since a large proportion of seropositive asymptomatic persons
shown to be viremic (5), all seropositive individuals, whether
not, must be presumed capable of transmitting this infection. A
reactive serologic test for HTLV-III/LAV has important medical, as
public health, implications for the individual and his/her
provider. The purpose of these recommendations is to suggest ways
facilitate identification of seropositive asymptomatic persons,
medical evaluation and for counseling to prevent transmission.
Previous U.S. Public Health Service recommendations pertaining
sexual, IV drug abuse, and perinatal transmission of HTLV-III/LAV
published (6-8). Reduction of sexual and IV transmission of
should be enhanced by using available serologic tests to give
infected individuals in high-risk groups the opportunity to know
so they can take appropriate steps to prevent the further
Since the objective of these additional recommendations is to
interrupt transmission by encouraging testing and counseling among
high-risk groups, careful attention must be paid to maintaining
confidentiality and to protecting records from any unauthorized
The ability of health departments to assure confidentiality -- and
confidence in that ability -- are crucial to efforts to increase
of persons requesting such testing and counseling. Without
confidentiality protection, anonymous testing should be considered.
tested anonymously would still be offered medical evaluation and
PERSONS AT INCREASED RISK OF HTLV-III/LAV INFECTION
Persons at increased risk of HTLV-III/LAV infection include:
homosexual and bisexual men; (2) present or past IV drug abusers;
with clinical or laboratory evidence of infection, such as those
or symptoms compatible with AIDS or AIDS-related complex (ARC); (4)
born in countries where heterosexual transmission is thought to
play a major
role *; (5) male or female prostitutes and their sex partners; (6)
partners of infected persons or persons at increased risk; (7) all
with hemophilia who have received clotting-factor products; and (8)
infants of high-risk or infected mothers.
Community health education programs should be aimed at members
risk groups to: (a) increase knowledge of AIDS; (b) facilitate
behavioral changes to reduce risks of HTLV-III/LAV infection;
encourage voluntary testing and counseling.
Counseling and voluntary serologic testing for HTLV-III/LAV
routinely offered to all persons at increased risk when they
health-care settings. Such facilities include, but are not
sexually transmitted disease clinics, clinics for treating
drug abusers, and clinics for examining prostitutes.
Persons with a repeatedly reactive test result (see
section on Test
Interpretation) should receive a thorough medical
may include history, physical examination, and
High-risk persons with a negative test result should be
to reduce their risk of becoming infected by:
(1) Reducing the number of sex partners. A stable,
monogamous relationship with an uninfected person
any new risk of sexually transmitted HTLV-III/LAV
(2) Protecting themselves during sexual activity with
infected person by taking appropriate precautions to
contact with the person's blood, semen, urine,
cervical secretions, or vaginal secretions.
efficacy of condoms in preventing infections with
is still under study, consistent use of condoms
transmission of HTLV-III/LAV by preventing exposure
and infected lymphocytes (9,10).
(3) For IV drug abusers, enrolling or continuing in
eliminate abuse of IV substances. Needles, other
and drugs must never be shared.
Infected persons should be counseled to prevent the
transmission of HTLV-III/LAV by:
(1) Informing prospective sex partners of his/her
HTLV-III/LAV, so they can take appropriate
Clearly, abstention from sexual activity with
is one option that would eliminate any risk of
transmitted HTLV-III/LAV infection.
(2) Protecting a partner during any sexual activity by
appropriate precautions to prevent that individual
into contact with the infected person's blood,
feces, saliva, cervical secretions, or vaginal
Although the efficacy of using condoms to prevent
with HTLV-III/LAV is still under study, consistent
condoms should reduce transmission of HTLV-III/LAV
preventing exposure to semen and infected
(3) Informing previous sex partners and any persons with
needles were shared of their potential exposure to
III/LAV and encouraging them to seek
(4) For IV drug abusers, enrolling or continuing in
eliminate abuse of IV substances. Needles, other
and drugs must never be shared.
(5) Not sharing toothbrushes, razors, or other items
become contaminated with blood.
(6) Refraining from donating blood, plasma, body organs,
tissue, or semen.
(7) Avoiding pregnancy until more is known about the
transmitting HTLV-III/LAV from mother to fetus or
(8) Cleaning and disinfecting surfaces on which blood or
body fluids have spilled, in accordance with
(9) Informing physicians, dentists, and other
professionals of his/her antibody status when
care so that the patient can be appropriately
Infected patients should be encouraged to refer sex partners
with whom they have shared needles to their health-care
evaluation and/or testing. If patients prefer, trained health
department professionals should be made available to assist in
their partners and counseling them regarding evaluation and/or
Persons with a negative test result should be counseled
need for continued evaluation to monitor their infection
status if they
continue high-risk behavior (8).
State and local health officials should evaluate the
requiring the reporting of repeatedly reactive HTLV-III/LAV
test results to the state health department.
State or local action is appropriate on public health grounds
regulate or close establishments where there is evidence that
facilitate high-risk behaviors, such as anonymous sexual
intercourse with multiple partners or IV drug abuse (e.g.,
houses of prostitution, "shooting galleries").
Commercially available tests to detect antibody to
enzyme-linked immunosorbant assays (ELISAs) using antigens derived
disrupted HTLV-III/LAV. When the ELISA is reactive on initial
testing, it is
standard procedure to repeat the test on the same specimen.
reactive tests are highly sensitive and specific for HTLV-III/LAV
However, since falsely positive tests occur, and the implications
positive test are serious, additional more specific tests (e.g.,
blot, immunofluorescent assay, etc.) are recommended following
reactive ELISA results, especially in low-prevalence populations.
additional more specific test results are not readily available,
high-risk groups with strong repeatedly reactive ELISA results can
counseled before any additional test results are received regarding
probable infection status, their need for medical follow-up, and
reduce further transmission of HTLV-III/LAV.
State or local policies governing informing and counseling sex
and those who share needles with persons who are
positive will vary, depending on state and local statutes that
actions. Accomplishing the objective of interrupting transmission
encouraging testing and counseling among persons in high-risk
depend heavily on health officials paying careful attention to
confidentiality and protecting records from unauthorized
The public health effectiveness of various approaches to
sex-partner referral, and laboratory testing will require careful
The feasibility and efficacy of each of these measures should be
state and local health departments to best utilize available
Developed by Center for Prevention Svcs and Center for Infectious
CDC, in consultation with persons from numerous other organizations
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* e.g., Haiti, Central African countries.
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