Infection Control · patient case question
Which is NOT a route of HIV transmission?
Patient case: A murmur, a virus and a bottle of hand sanitizer
Patient: Two patients and a practice question
Chief Complaint: A: “I need this broken tooth out.” B: attends with his sister, who has questions.
Background: A, 52-year-old male: a heart murmur was noted years ago at a routine physical and never investigated further. No prosthetic valve, no previous endocarditis, no congenital heart disease, no transplant. B, 38-year-old male: HIV positive, on antiretroviral therapy, viral load undetectable, CD4 610. His sister asks whether it is safe for the family to share utensils with him.
Vital Signs: A: BP 126/78 mmHg · HR 74 bpm
Findings: A: tooth #31 non-restorable. Alcohol-based hand rub is in use throughout the practice.
Show answer and explanation
Correct answer: A. Contact with contaminated inanimate objects such as shared utensils or door handles
- A. CORRECT as the exception. HIV is a FRAGILE ENVELOPED virus that does not survive on environmental surfaces and is not present in saliva in infectious quantities. There is NO documented transmission by fomites, casual contact, shared utensils or crockery, toilet seats, swimming pools, insect bites, coughing or sneezing. This matters practically as well as scientifically: unfounded fear of casual transmission drives discriminatory refusal of care, which is both an ethical violation and unlawful under disability legislation.
- B. Vertical transmission IS a route — in utero, during delivery, and through breastfeeding. It is now largely preventable with maternal antiretroviral therapy, which is one of the major public health successes in this disease.
- C. Sexual contact IS the commonest route of transmission worldwide, through exposure of mucosal surfaces to infected genital secretions.
- D. Percutaneous injury from a hollow-bore needle contaminated with infected blood IS a genuine occupational route. The seroconversion risk is approximately 0.3% — far below hepatitis B at up to 30% in an unvaccinated worker, and below hepatitis C at about 1.8%.
Note: Reassure the sister directly and specifically. For the practice, STANDARD PRECAUTIONS apply to every patient regardless of known status, and no additional infection control measures are required for a patient known to be HIV positive — that is the entire logic of standard precautions. This patient's undetectable viral load and CD4 of 610 also mean routine dental care proceeds without modification.
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