Did you know that infected needles are among the most common causes of HIV? Preventing transmission of HIV to yourself eliminates the need for treatment of HIV.

Needles And HIV: Is There A Link?

Introduction

If an HIV-negative person comes in contact with equipment previously used by an<a href="https://www.merisehat.pk/article/i-have-hiv-what-are-my-treatment-options"> HIV-positive person</a>, their risk of contracting the infection becomes extremely high. Equipment such as needles and injections can become contaminated with the blood of an HIV-positive person. If these needles are not sterilized properly or are reused, they can transmit the virus to others. Moreover, <a href="https://www.merisehat.pk/disease/hiv-61">HIV</a> can survive in a used syringe for forty-two days, depending on the temperature and other factors<a href="#accordion">[1]</a>.

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Understanding the spread of HIV via infected needles

A needle-stick injury is defined as the accidental puncturing of the skin with a used needle that has been exposed to blood, tissue, or bodily fluids. All sharps which include needles, scalpels, razors, broken glass, and cutters pose a risk of injury. 
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<ul>
	<li>
	<h5>Needle Stick Injury- Occupational Exposure&nbsp;</h5>
	</li>
</ul>

Needle-stick injuries are most common in healthcare workers. This is called occupational exposure. As per estimates, globally, more than three million healthcare workers are exposed to needle-stick injuries per year, including one million in Europe<a href="#accordion">[2]</a>. However, documented injuries that lead to HIV infections are very rare. 
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<ul>
	<li>
	<h5>Needle Stick Injury- non-occupational exposure</h5>
	</li>
</ul>

Injuries from discarded needles are not very common, and the infections caused by them are also rare. This is called non-occupational exposure. Although there is no documentation of non-occupational exposure causing HIV infections around the world, in Pakistan, it is unfortunately not a very rare occurrence.&nbsp;

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In addition to HIV, other blood-borne viruses such as hepatitis B and C can also be transmitted via infected needles. The transmission risk is contingent on whether the person who used the object previously carried the infection. It also depends on the level of infection in the blood, the quantity of blood involved, and the type of syringe or needle. Moreover, this also includes the time that has elapsed since the needle has been used; the nature of the injury is also taken into consideration.

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People who inject drugs (PWID) are at a higher risk of HIV, especially if they use infected needles and syringes. For example, drug abusers.

Although cases have been stable for the past few years, using drugs via injections and syringes has created prevention challenges in the United States. Therefore, emphasis is placed on preventing infections in PWID, by coverage expansion and supporting comprehensive Syringe Services Programs (SSP). 
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Cases have increased in countries where injection of drugs is a common occurrence. HIV among drug users has become a global challenge<a href="#accordion">[3]</a>. Although existing data isn&rsquo;t very adequate, it is viewed as an important aspect, considering the increase in HIV transmission across several regions<a href="#accordion">[3].</a>

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Since 2013, the United States has reported a total of 58 confirmed cases of occupational HIV transmission in healthcare workers. Moreover, only one case has been reported since 1999<a href="#accordion">[4].</a> In the United Kingdom, only 5 definitive cases of HIV infection due to a needle-stick injury have been reported in healthcare settings over the past twenty years<a href="#accordion">[5]</a>. Whereas a total of 100 needle-stick injury cases have been reported in healthcare set-ups<a href="#accordion">[6]</a>.&nbsp;Furthermore, between 2004 and 2013, a total of 1478 healthcare workers were exposed to HIV-infected blood<a href="#accordion">[5].</a>&nbsp;Three-quarters of the healthcare workers took PEP (post-exposure prophylaxis), and almost all of them did so within twenty-four hours. No HIV infection was reported in any of the cases.

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Unsterile medical practices are one of the major reasons behind the transmission of blood-borne viruses, including HIV. These include blood transfusions, vaccinations, therapeutic injections, and invasive surgeries. It can be theorized that these unsafe practices led to the emergence of HIV in Central and West Africa, in the twentieth century.&nbsp; 
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The importance of HIV transmission through blood transfusion was first identified when the developing world discovered that blood transmits viral infections more effectively than other means. Although the risk of HIV from blood transfusions was identified in sub-Saharan African regions, HIV blood screening tests did not become available till a decade later, in 1985<a href="#accordion">[7]</a>. 
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Although, initially there had been delays, most countries are now working to screen blood samples and ensure safe injections. Moreover, better disposal practices have also been implemented.

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The current estimate indicates that 110,000 people in the UK are living with HIV. Furthermore, the overall prevalence is 2.8 per 1000 population between the ages of fifteen and fifty-nine<a href="#accordion">[9]</a>. 
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1. One of the possible causes of HIV is needle sharing between drug users. 
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2. In low-income countries, primary care centers often have limited resources, and there have been instances wherein the same syringe or even IV drip bags were used for multiple patients. However, these instances have been few and far between, and the local health authorities were immediately notified. As a result, local health authorities were able to respond immediately and strict action was taken to curb HIV transmission. These actions included sealing the primary care centers<a href="#accordion">[8]</a>. 
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3. Occupational needle-stick injuries are highly unlikely, but an unfortunate causative factor in spreading.&nbsp;

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Conclusion

Post-exposure prophylaxis is given after exposure to HIV-contaminated blood or sharps. PEP has an effectiveness of 80% in preventing HIV from needle-stick injuries<a href="#accordion">[10]</a>.&nbsp;A different form of PEP that protects against hepatitis B is also available.&nbsp; 
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People who have had occupational exposure to HIV should seek treatment immediately. The effect of post-exposure prophylaxis is highest when given within 72 hours of exposure. However, initiating therapy is recommended within two hours of exposure.

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Key Points

<ul>
	<li>The risk of HIV through needle-stick injury is less than 1%, and for direct skin contact with the fluid is less than 0.1%. Thus, it varies between 0.1% to 1%<a href="#accordion">[11]</a>.</li>
	<li>PEP should be given immediately after needle-stick injuries infected with HIV. Moreover, precautions should be taken to prevent this from happening again in the country.</li>
</ul>

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[1].Abdala, N., Reyes, R., Carney, J.M. and Heimer, R., 2000. Survival of HIV-1 in syringes: effects of temperature during storage. Substance use & misuse, 35(10), pp.1369-1383.

[2].Bouya, S., Balouchi, A., Rafiemanesh, H., Amirshahi, M., Dastres, M., Moghadam, M.P., Behnamfar, N., Shyeback, M., Badakhsh, M., Allahyari, J. and Al Mawali, A., 2020. Global prevalence and device related causes of needle stick injuries among health care workers: a systematic review and meta-analysis. Annals of global health, 86(1).

[3].Mathers, B.M., Degenhardt, L., Phillips, B., Wiessing, L., Hickman, M., Strathdee, S.A., Wodak, A., Panda, S., Tyndall, M., Toufik, A. and Mattick, R.P., 2008. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet, 372(9651), pp.1733-1745.

[4].Joyce, M.P., Kuhar, D. and Brooks, J.T., 2015. Occupationally acquired HIV infection among health care workers—United States, 1985–2013. MMWR. Morbidity and Mortality Weekly Report, 63(53), p.1245.

[5].United Kingdom surveillance of significant occupational ... - gov.uk.

[6].Elseviers, M.M., Arias‐Guillén, M., Gorke, A. and Arens, H.J., 2014. Sharps injuries amongst healthcare workers: review of incidence, transmissions and costs. Journal of renal care, 40(3), pp.150-156.

[7].Wyżgowski, P., Rosiek, A., Grzela, T. and Leksowski, K., 2016. Occupational HIV risk for health care workers: risk factor and the risk of infection in the course of professional activities. Therapeutics and clinical risk management, 12, p.989.

[8].Schneider, W.H. and Drucker, E., 2006. Blood transfusions in the early years of AIDS in sub-Saharan Africa. American Journal of public health, 96(6), pp.984-994.

[9].Zheng, M.Y., Suneja, A., Chou, A.L. and Arya, M., 2014. Physician barriers to successful implementation of US Preventive Services Task Force routine HIV testing recommendations. Journal of the International Association of Providers of AIDS Care (JIAPAC), 13(3), pp.200-205

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