Anyone bitten by an HIV-positive person must be given prophylactic (preventative) treatment to ward off the possibility of infection, say the latest American guidelines on treating HIV, released earlier this year. The guidelines cite a case study from Mumbai, in which HIV was transmitted through a human bite because the doctor in charge did not administer any prophylactic treatment to the bitten person. In all, three such cases from around the world were cited in the guidelines released by the Society for Healthcare Epidemiology of America, a non-governmental body.
What was the cited case from Mumbai?
In the 2010 case of a 44-year-old father who was bitten by his HIV-infected stepson in Mumbai, the doctor had advised the father not to take any prophylaxis medication. In a gross case of negligence, the doctor assumed that because transmission of HIV from saliva to blood is rare, the father would not get infected by HIV. But he was.
The 44-year-old father was admitted to state-run JJ Hospital on March 29, 2010 with high fever and drowsiness. Prior to admission, he had been unwell for four days. His HIV test came up positive, which baffled the doctors. The father had denied having any history of unprotected sex or usage of intravenous drugs. Also, his wife was HIV negative.
On further probing, the father revealed to the doctors that his stepson, who was HIV-positive, had severely bitten him on the left thumb. He recounted how his thumb nail was ripped off after the bite, leaving behind a raw bleeding nail-bed.
Based in part on this case, the guidelines observe that even a patient whose semen or saliva do not show traces of the HIV virus should be given prophylactic treatment.
Why is this revision important?
The revision in the guidelines is significant for India, since many doctors here consider the risk of infection through human bites too insignificant to merit giving prophylactic drugs to the bitten person. Prophylaxis is the medication immediately provided to a person who is at risk of being infected by HIV.
The chance of transmission from saliva of the HIV-infected patient to a victim's wound is 0.09%.
What does an Indian expert say?
"It is possible to get infected through human bite. The treating physician, instead of ruling out infection, should have put the father on post-exposure prophylaxis (PEP) medication, which is a 28-day course. It is absolutely necessary to treat HIV-infected human bites with PEP, even when transmission is via saliva," said Dr Atmaram Bandivdekar, head, department of biochemistry, National Institute for Research in Reproductive Health (NIRRH). Dr. Bandivdekar is one of the researchers who had documented the 2010 bite case from Mumbai.
Does India have guidelines of its own?
Yes, but as the 2010 Mumbai case study shows, there seems to be a variation in doctors' interpretation of the guidelines.
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