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Ok, Lets put this to rest
Apr 7, 2001

Dr. Little, Before i get to my question, let me say welcome aboard! I've been following the body since its inception, its a very valueable site, now, onto my question. For once and for all, which is "riskier" giving OR receiving unprotected Oral sex? We so often hear how while saliva may be infectious, yet only with some "visible" blood. I'd like to hear your thoughts on this one. I apologize in advance, this is not a resistance question.

Response from Dr. Little

Thanks for the welcome. The easy way out is to say that we do not know the answer to your question. I am comfortable speculating, but this is only my opinion, not the dogma from the literature, which is incomplete on this subject. One of the major factors clearly associated with the risk of heterosexual transmission (and I assume gay sex as well) is the viral load in the HIV positive member of the couple. The higher the viral load, the greater the risk of transmission. Since the method of transfer of viral particles is generally genital secretions, then the level of virus within these secretions is almost certainly associated with the risk of transmission. Since the source of virus in many fluids is generally blood cells, then the greater the cellular content, particularly of HIV-infected cells, the greater the risk is also likely to be. Having said this, the saliva from healthy mouths (without mouth sores, bleeding gums, and/or other breaks in the normal healthy mucosal lining) does not generally have many cells and thus is probably very low risk for HIV transission of virus. In the case of oral sex, we generally think that the risk is greatest for the person "receiving" oral sex (otherwise known as receptive oral sex) if this involves the receipt of genital secretions. Receptive oral sex without transfer of genital secretions is probably lower risk, but again, most of this is theory based upon a small amount of actual data. This is why you may get 5 different answers from 5 different physicians. What you are really getting is 5 different opinions. Some day I hope we can find the true "bottom line" on this topic. For now, I generally advise that the more secretions transferred and the higher the viral load in the blood, the greater the likelyhood of transmitting virus. There are however, a host of other factors which probably play a role (ie. circumcision thought to reduce risk of acquiring and transmitting infection in heterosexual sex regardless of whether the man is the positive or negative partner, etc.). Sorry I cannot give you the definitive answer. We'll keep working on getting enough data to answer this question more definitively in the near future I hope.

False Hopes??
Same question again regarding Zerit/Ziagen to Viramune and Trizivir

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