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Some stats here.......and questions
Sep 10, 1997

1. On a recent HIV report in my country (Malaysia), it indicates that until the end of 1996, there are 20 084 cases of HIV cases. 55.3% of them are from intravenous drug use, 1.3% from blood products and 15.7%, unknown or uncertain mode of transmission. At the moment, the and average of 350 cases are reported monthly nationwide, with a decreasing trend for 1997. There is one thing that disturbs me is that the percentage of 'uncertain mode of transmission' is very high (15.7% or about 3000 cases). Based on your knowledge, can you suggest some reasons for this unsual data ? 2. Secondly, on a recent trip to a dermatologist, I was given local anaesthetic. I noticed that the some of the bottles of medicine (which are to be injected) already have needles (not the whole syringe, just the needles) poking through the bottle's permeable seal. Why does the doctor do that ? Is it a normal practice? Could it mean that the doctor might be re-using needles ? Since I am a patient of his, am I at risk of contracting HIV or other diseases ?

Response from Mr. Sowadsky

Hi. Thank you for your question. The only statistics that I have for Malaysia are for full-blown AIDS. Based on the latest information available from the World Health Organization, the number of AIDS cases in Malaysia is 580, as of 3 May, 1996. I do not have any data for HIV cases in Malaysia.

We sometimes find HIV/AIDS cases where the risk factor cannot be determined. This is most often due to lack of reporting, rather than new ways that HIV may be transmitted. Let me give you some AIDS statistics for the United States as an example of what I mean.

Out of 581,429 cases of AIDS in the United States (as of 31 December, 1996), there were 8,181 cases where we do not know a risk factor because the patient:

1) died before they could be interviewed,

2) declined to be interviewed regarding their risk factors, or

3) were lost to follow-up (they moved) and could not be found to interview.

These cases do not represent new ways that HIV is being transmitted. Rather, they are cases where the information was not able to be collected. If a person refuses to cooperate with health officials or doctors, is lost to follow-up if they move out of the area, or if they die before we can determine their risk, these individuals would be classified as having an unknown risk factor for HIV infection. In addition, if the data (risk factors) are simply not collected, this would also be classified as an unknown risk factor. This doesn't mean that HIV is being transmitted in a new way. What it does mean, is that we were unable to collect the information, or have not yet collected the information. Statistics like these can be very easily misinterpreted.

In addition, out of the 581,429 cases of AIDS in the United States (as of 31 December, 1996), in only 903 cases, were we truly not able to determine the source of infection, even when the patient was interviewed for their risk factors. Of these cases, this includes heterosexual contact with a person not known to be HIV positive or at high risk for HIV, persons who chose not to disclose their risk factors for HIV (which is not an unusual occurrence), and persons with possible occupational exposures. These 903 persons included:

1) Individuals having a history of other Sexually Transmitted Diseases (STD's) indicating high risk sexual exposures,

2) Individuals with Hepatitis infections (Hepatitis B and C share similar routes of transmission as HIV),

3) Individuals engaging in heterosexual contact (a well-known route of HIV transmission),

4) Individuals having a history of non-IV drug use (alcohol and other judgement affecting drugs, has a well-known link to HIV, due to behavior changes while under the influence of these drugs) and,

5) Individuals having occupational exposures to blood or body fluids.

So out of the literally thousands of cases of AIDS reported in the United States, in only a small number of cases were we truly not able to determine a definitive source of infection (when the patient was able to be interviewed). But many of these individuals did have known risk behaviors, and markers of risky exposures. There is no evidence that anybody has been infected through casual contact worldwide.

Therefore, when HIV/AIDS data states risk factors as being "unknown or uncertain mode of transmission," this often means that the data has not yet been reported, or was unable to be collected. These data do NOT indicate that HIV is being transmitted in new ways! In some countries, reporting of risk data is collected better than in other countries. In some countries, "unknown or uncertain mode of transmission" is simply due to lack of reporting of this data. The unknown risk factors for the cases in Malaysia may be due to similar data collection limitations as discussed above.

Regarding the risks from your doctors office, as long as your doctor is following established infection control guidelines and practices, you would not be at any risk for HIV, or other bloodborne diseases. If established infection control practices are followed, you would not be exposed to the blood of any other patient.

If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).



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