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What up with the risk exposure stats?
Jul 10, 2005

Hello!

Just want to say that I enjoy your advice and have been reading the archives for some time and getting a good laugh. Now I get to actually participate and ask you a question. I consider myself to be pretty informative about the transmission and prevention of HIV but there is one thing I haven't figured out. I notice that in alot of your responses you tell the people that their risk of infection is 5 per 10,000 exposures to an HIV-infected partner or something along those lines with various numbers. I wanted to know if that was a percentage or something else altogether? I called the CDC hotline and asked two different people and both times the gentlemen I were talking to had no idea what I was asking. I even read them a quote directly from your site and one of them even responded that they had no idea how you came up with those statistics and that I should stop reading such nonsense. The other gentleman said basicly the same thing only adding that in order to get those types of numbers you would have to test the same person everytime they had a risk exposure which would be impossible. So what is the deal with the statistics? The mathmatically challenged want to know!

P.S. Doesn't it scare you that they have (some) people working at the CDC who are so unknowledgable?

Response from Dr. Frascino

Hi,

Ideally, I would prefer to advise folks their risk of acquiring HIV is either "high or low," or "significant or insignificant;" however, everyone wants to know how high, how low, how significant and how insignificant. My preference here would be to tell folks that if they feel they've placed themselves at risk for HIV, get tested at the three-month mark. But as you can tell from the many questions posted here, these types of answers do not satisfy most of the anxious worried-wells. So I've tried to provide the most accurate statistical estimates of risk that are available from published epidemiological studies.

Certainly some routes of exposure are more risky than others. If I were to rank the level of risk (riskiest to less risky), it would look like this:

1. blood transfusion with infected blood

2. needle-sharing injection drug use with an HIV-positive person

3. receptive anal

4. needlestick (from HIV-positive person)

5. receptive vaginal

6. insertive anal

7. insertive vaginal

8. receptive oral

9. insertive oral

Large epidemiological studies have allowed us to develop "estimated per-act risk" for these activities. These are not absolute numbers, but rather estimates of risk based on limited data sets.

The figures I've been quoting over recent months actually come from can you guess? yep, a CDC document!!! It was published in January of this year and pertains primarily to the recommendations from the U.S. Department of Health and Human Services for Antiretroviral Post-Exposure Prophylaxis After Sex, Injection-Drug Use, or Other Nonoccupational Exposures to HIV in the United States.

Apparently the CDC hotline guys you talked to either

1. didn't get the memo,

2. didn't bother to read the memo or

3. can't read the memo.

At any rate, next time you chat with the gents, you could recommend they read their own literature. This report was published in the MMWR Jan. 21, 2005/54(RR02);1-20.

Stay well. Stay informed.

Dr. Bob



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