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Current Trends Additional Recommendations to Reduce Sexual and Drug Abuse-Related Transmission of Human T-Lymphotropic Virus Type III/ Lymphadenopathy-Associated Virus
Human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV), the virus that causes acquired immunodeficiency syndrome (AIDS), is transmitted through sexual contact, parenteral exposure to infected blood or blood components, and perinatally from mother to fetus or neonate. In the United States, over 73% of adult AIDS patients are homosexual or bisexual men; 11% of these males also had a history of intravenous (IV) drug abuse. Seventeen percent of all adult AIDS patients were heterosexual men or women who abused IV drugs (1,2). The prevalence of HTLV-III/LAV antibody is high in certain risk groups in the United States (3,4).
Since a large proportion of seropositive asymptomatic persons have been shown to be viremic (5), all seropositive individuals, whether symptomatic or not, must be presumed capable of transmitting this infection. A repeatedly reactive serologic test for HTLV-III/LAV has important medical, as well as public health, implications for the individual and his/her health-care provider. The purpose of these recommendations is to suggest ways to facilitate identification of seropositive asymptomatic persons, both for medical evaluation and for counseling to prevent transmission.
Previous U.S. Public Health Service recommendations pertaining to sexual, IV drug abuse, and perinatal transmission of HTLV-III/LAV have been published (6-8). Reduction of sexual and IV transmission of HTLV-III/LAV should be enhanced by using available serologic tests to give asymptomatic, infected individuals in high-risk groups the opportunity to know their status so they can take appropriate steps to prevent the further transmission of this virus.
Since the objective of these additional recommendations is to help interrupt transmission by encouraging testing and counseling among persons in high-risk groups, careful attention must be paid to maintaining confidentiality and to protecting records from any unauthorized disclosure. The ability of health departments to assure confidentiality -- and the public confidence in that ability -- are crucial to efforts to increase the number of persons requesting such testing and counseling. Without appropriate confidentiality protection, anonymous testing should be considered. Persons tested anonymously would still be offered medical evaluation and counseling.
PERSONS AT INCREASED RISK OF HTLV-III/LAV INFECTION
Persons at increased risk of HTLV-III/LAV infection include: (1) homosexual and bisexual men; (2) present or past IV drug abusers; (3) persons with clinical or laboratory evidence of infection, such as those with signs or symptoms compatible with AIDS or AIDS-related complex (ARC); (4) persons born in countries where heterosexual transmission is thought to play a major role *; (5) male or female prostitutes and their sex partners; (6) sex partners of infected persons or persons at increased risk; (7) all persons with hemophilia who have received clotting-factor products; and (8) newborn infants of high-risk or infected mothers.
Commercially available tests to detect antibody to HTLV-III/LAV are enzyme-linked immunosorbant assays (ELISAs) using antigens derived from disrupted HTLV-III/LAV. When the ELISA is reactive on initial testing, it is standard procedure to repeat the test on the same specimen. Repeatedly reactive tests are highly sensitive and specific for HTLV-III/LAV antibody. However, since falsely positive tests occur, and the implications of a positive test are serious, additional more specific tests (e.g., Western blot, immunofluorescent assay, etc.) are recommended following repeatedly reactive ELISA results, especially in low-prevalence populations. If additional more specific test results are not readily available, persons in high-risk groups with strong repeatedly reactive ELISA results can be counseled before any additional test results are received regarding their probable infection status, their need for medical follow-up, and ways to reduce further transmission of HTLV-III/LAV.
State or local policies governing informing and counseling sex partners and those who share needles with persons who are HTLV-III/LAV-antibody positive will vary, depending on state and local statutes that authorize such actions. Accomplishing the objective of interrupting transmission by encouraging testing and counseling among persons in high-risk groups will depend heavily on health officials paying careful attention to maintaining confidentiality and protecting records from unauthorized disclosure.
The public health effectiveness of various approaches to counseling, sex-partner referral, and laboratory testing will require careful monitoring. The feasibility and efficacy of each of these measures should be evaluated by state and local health departments to best utilize available resources.
Developed by Center for Prevention Svcs and Center for Infectious Diseases, CDC, in consultation with persons from numerous other organizations and groups.
* e.g., Haiti, Central African countries.
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