Introduction
1. Epidemiology
2. Family Studies
3. Health Care Workers
4. Biology of the HTV
REFERENCES
Acquired Immunodeficiency
Syndrome (AIDS) is a disease of the immune system, associated
with the HTLV-III/LAV virus (HTL). In current thinking, helper
T-cells, which play an important role in the body's response to
infection, are colonized by HTL. In a fashion typical of viral
illnesses, the infecting virus upsets the host cell and uses the
host cell's genetic material to accomplish viral reproduction.
This turns the host cell into a sort of virus factory, producing
more and more HTVs. As further T-cells are infected by the new
viruses, the body loses a major arm of its defense against bacterial,
parasitic, and certain cancerous diseases. In full blown AIDS,
the patient develops opportunistic infections such as Pneumocystis
Carinii pneumonia, which are very rare in persons possessing
intact immune systems. Despite aggressive medical therapy, such
infections in AIDS patients carry a grave prognosis; indeed, of
approximately 13,200 Americans diagnosed as having AIDS by Sept.
16, 1985, 6760 have died. Most deaths were due to infection.[4]
That virtually all AIDS occurs in gay or bisexual men, intravenous drug abusers, hemophiliacs, transfusion recipients, newborn infants and heterosexual contacts of persons with or at high risk of developing AIDS shows that this disease is transmitted by sexual contact, by sharing of blood, and at birth. * Since the HTV has been found in human blood, saliva, tears, breast milk, semen, urine, and female sexual secretions,[10] it is relevant to ask if the disease may be transmitted by more casual means, such as the sharing of an oboe reed. Happily, a substantial body of evidence indicates that AIDS is not transmitted by other than sexual, blood-to-blood, or birth contact.[7]
1.
Epidemiology
Of the 15,000 cases of AIDS
reported nationally, only 6% do not admit to being in a high risk
group (homosexual and bisexual men, intravenous drug abusers,
hemophiliacs, recipients of transfusions before 1984, or persons
having heterosexual relations with another person falling into
any of these groups). These 6% include Haitians and patients who
could not be interviewed. Importantly, the low proportions of
cases outside the high risk groups have remained constant since
the epidemic was noted in 1981. Were HTV transmitted by casual
exposure to saliva and other body fluids, the proportion of cases
outside of the major risk groups would be expected to steadily
increase.[7]
2.
Family Studies
No cases of AIDS in non-sexual
household contacts of AIDS patients are known. Nine studies have
evaluated the transmission of HTV among family members of over
400 AIDS cases. Despite the repeated exposure to sweat and saliva
that occurs in daily living by sharing kitchen utensils, kissing,
physical contact and sharing bathrooms - the failure to demonstrate
HTV transmission in these circumstances demonstrates that the
disease is not transmitted even by repeated casual contact.[2]
3.
Health Care Workers
In six studies, over 1,750
nurses, technicians, and physicians who had cared for AIDS patients
have been tested for antibodies to HTV.[6,9]
Of these, 666 people had direct exposure to the blood or saliva
of AIDS patients by needlesticks, cut skin at surgery, or mucous
membrane contact. Only 26 of the entire 1,750 show evidence of
exposure to HTV; of these, 23 are members of high risk groups
and must be discounted. Of the remaining three workers, one had
sustained a needle injury from an AIDS patient, and one had been
repeatedly exposed in the lab to spilled blood of AIDS patients.
The third was not available to provide exposure information. Although
all three of these people showed laboratory evidence of exposure
to HTV, none have actually developed AIDS. It thus appears that
even in persons directly exposed to HTV-contaminated blood, the
risk of transmission is small - less than 1 %. No health care
professional has developed HTV infection from exposure to saliva,
tears, urine, vomit, or feces of AIDS patients. Note that the
risk of developing Hepatitis B following a needlestick from a
carrier of that virus is in the range of 6 to 30%, far in excess
of the risk of developing AIDS in similar circumstances.[7,8]
4. Biology
of the HTV
Many properties of the HTV
make it an unlikely candidate for musical transmission. First,
it is rarely found in the saliva; in one study of 71 gay men with
evidence of exposure to HTV, 40 showed the virus in their blood;
only one had the virus in his saliva.[5] At least five other studies have confirmed this
finding.
Second, the virus can survive and replicate only in the T-lymphocyte cells of the blood and lymphatic systems. Thus, many of our natural defense mechanisms effectively eliminate the possibility of infection from saliva encountered on a reed. In a very real sense, the virus must be "injected" into the bloodstream for AIDS to develop.
Third, the virus is killed by many common cleaning agents, including lysol, alcohols, bleach, peroxide, formaldehyde, many soaps, heat, iodine, weak acids, and weak alkalis.[3,7]
Knowledge of the means of transmission of AIDS is more complete than for many other viral diseases, such as the common cold. All available evidence implies that exposure other than by sexual or blood contact does not constitute a risk for the development of AIDS.[1]
Despite these reassurances, the concerned reader might still be uneasy about the chances of developing a fatal disease by trying a student's latest reed-making efforts. Because 100% assurances can never be given in medicine, I would suggest a simple method for avoiding the transmission of HTV among musicians. First, avoid blood or sexual contact with persons who have or may be at risk for AIDS (as outlined above). Second, if you wish to try another musician's reed or mouthpiece, disinfect it simply and quickly before and after you try it. A vial of 70% ethanol (140 proof whiskey), hydrogen peroxide, or isopropanol (rubbing alcohol) can be kept handy, just as a water filled vial is by many double-reed players. Swirl the suspect reed in this, shaking the fluid out of the tip before and after the swirling, and you will kill such HTV as may be harbored in your colleague's saliva on the reed. Do NOT fill your vial with Lysol, bleach, formaldehyde or strong chemicals, unless you care to ruin your health with poisons - a much more likely event than catching AIDS from a reed. These measures will also make it unlikely that you will catch hepatitis or a cold from that reed.
To summarize, all available evidence suggests that AIDS is transmitted by the sharing of blood or sexual fluids of an infected person. Simple hygienic measures which kill the HTV may be employed to lessen the chance - virtually nil to begin with - of transmission from a musical instrument or reed.
REFERENCES
1.
Sande, M.A. Transmission of AIDS. New England Journal of Medicine,
vol. 314, no. 6, pp 380-2. 2/6/86
2. Friedland, G.H. et al. Lack of Transmission of HTLV-III/LAV Infection to Household Contacts of Patients with AIDS... New England Journal of Medicine, vol. 314, no. 6, pp 344-349. 2/6/86
3. Silverman, P.R. Recommendations for Preventing Transmission of Infection with HTLVIII (AIDS) in the Workplace. Delaware Monthly Surveillance Report, vol. 86, no. 2. February 1986.
4. Francis, D.P. and Petricciani, J.C. The Prospects for and Pathways Toward a Vaccine for AIDS. New England Journal of Medicine, vol. 313, no. 25. 12/19/85 pp. 1586-1590
5. Ho, D.D. et al. Infrequency of Isolation of HTLV-111 Virus from Saliva in AIDS. New England Journal of Medicine vol. 313, no. 25, pg 1606. 12/19/85
6. Saviteer, S.M. et al. HTLV-III Exposure During Cardiopulmonary Resuscitation. New England Journal of Medicine, vol. 313, no. 25, pp 1606-7. 12/19/85
7. Silverman, P.R. How Contagious is AIDS? Delaware Monthly Surveillance Report, vol. 85, no. 12. December 1985.
8. Grouse, L.D. HTLV-III Transmission. Journal of the American Medical Association, vol. 254, no. 15. pp 2130-31. 10/18/85
9. Weiss, S.H. et al. HTLV-111 Infection Among Health Care Workers. Journal of the American Medical Association, vol. 254, no. 15, pp 2089-93. 10/18/85
10. Redfield, R.R. et al. Heterosexually Acquired HTLV-III/LAV Disease. Journal of the American Medical Association, vol. 254, no. 15, pp 2094-6. 10/15/85.