Human Immunodeficiency virus (HIV) Agent Information Sheet

Boston University
Research Occupational Health Program (ROHP)
617-358-7647

Agent

Human Immunodeficiency virus (HIV) is a member of the retroviridae family and is an enveloped icosahedral virus of about 100 to 110 nm in diameter. There are two known strains: HIV-1 and HIV-2 which both cause human disease. Previous names for the virus include human T-lymphotropic virus-III (HTLV-III), lymphadenopathy-associated virus (LAV), and AIDS-associated retrovirus (ARV).

Disease/Infection

HIV infection can lead to Acquired Immune Deficiency Syndrome (AIDS), where the infected person becomes vulnerable to a wide range of other bacterial, viral, fungal and parasitic infections. AIDS is also marked by higher incidence of certain cancers, neurological conditions and cardiovascular events.

Pathogenicity

AIDS is characterized by symptoms and infections caused by the breakdown of the immune system (by destruction or functional impairment of CD4 receptors) due to HIV infection. HIV can infect many cell types, mainly lymphocytes, but also macrophages, and microglia in the brain, and other neurological cells.

Biosafety Information

Risk Group/BSL
Risk Group 3
Biosafety level 2, 2 (enhanced) or 3

Modes of Transmission
HIV can be spread through accidental needle sticks or contact with contaminated fluids. Very rarely, HIV spreads through transfusion of contaminated blood or blood components. There is a .3% infection rate from hollow bore needle stick. If tissues or organs from an infected person are transplanted, the recipient may acquire HIV. Very few people, who come in contact with HIV, actually become infected. Transmission can be further prevented through timely use of prophylactic antiviral medications (within 1 week, and ideally within first 72 hours of exposure).

Host Range/Reservoir
Humans

Symptoms
The clinical features of HIV infection vary depending on the stage of the disease. Acute infection is accompanied by non-specific “flu-like” and “mononucleosis-like” symptoms such as myalgia, arthralgia, diarrhea, nausea, vomiting, headache, hepatosplenomegaly, weight loss, and neurological symptoms⁾. Many people do not have any symptoms when they first become infected. Some exposed individuals may develop a mono-like illness within two or four weeks to up to 10 months of exposure. This illness can present with fever, enlarged lymph nodes, rash, headaches, general malaise, and sore throat. More seriously manifestations may include meningitis. These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. During this period, people are very infectious, and HIV is present in large quantities in genital fluids.

Early-stage disease refers to the period of clinical latency between the time of the primary infection and the development of symptoms indicative of advanced immunodeficiency. Typically, when the patient’s CD4+ T-cell count falls below 500 cells/µL, syndromes indicative of depressed cell mediated immunity can appear, including vulnerability to a wide range of other bacterial, viral, fungal and parasitic infections. AIDS has also been associated with higher incidence of certain cancers, neurological conditions and cardiovascular events. Long term HIV infection is associated with increased metabolic disorders.

Incubation Period
The incubation period varies. Commonly the time from infection to the development of detectable antibodies is generally 1 to 3 months; however, the time from HIV infection to diagnosis of AIDS had an observed range of less than 1 year to 15 years or longer.

Viability
HIV is susceptible to fresh 2% glutaraldehyde, 2% Jodopax (detergent and iodine), hypochlorite, iodine, phenolics, and to a lesser extent 70% ethanol, NaOH and isopropanol.

Survival Outside Host
HIV can remain viable in blood in syringes at room temperature for 42 days, and in blood and cerebrospinal fluid from autopsies for up to 11 days. Although drying in the environment is known to cause a rapid reduction in HIV concentration, under experimental conditions, Cell-free HIV dried onto a glass coverslip in 10% serum can survive for longer than 7 days, depending on the initial titer.

Information for Lab Workers

Laboratory PPE

Lab coats, gowns, splash shields, face and eye protection, and gloves or gowning specific to BSL-3 facilities.

Containment

Research on HIV should be conducted using Biosafety Level 2/3 containment, practices and equipment.   Work involving clinical specimens and non-culture procedures should occur in BSL- 2 facilities and practices. For all work culturing HIV and for activities involving non-human primates and any animals experimentally infected or inoculated with HIV, BSL-3 facilities, equipment, and operational practices should be used. Manipulations of the virus must be conducted in primary containment equipment such as a BSC or safety centrifuge cups.

Secondary barriers such as hand washing sinks and waste decontamination facilities must be available to reduce potential environmental contamination.

In Case of Exposure/Disease

• For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…):
  • Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
  • Charles River Campus: call or have a coworker call campus security at 617-353-2121.
    You will be referred to or transported to the appropriate health care location by the emergency response team.
• For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
• Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
• Provide the wallet-size agent ID card to the physician.

Vaccination

No vaccine available for HIV

Information for First Responders/Medical Personnel

Public Health Issues

There is a risk of infection if blood or body fluids containing the virus comes in contact with broken skin or contacts mucosal tissue via a splash. Standard precautions should be used.

Diagnosis/Surveillance

HIV is diagnosed by tests that assess whether an individual’s immune system has produced an HIV-specific immune response. Common tests include the indirect binding assay, antibody capture assay, the double antigen sandwich, ELISA, immunofluorescence, Western blotting, line immunoassays, and PCR, as well as viral isolation.

First Aid/Post Exposure Prophylaxis

Perform one of the following actions:

Treatment

HIV post exposure prophylaxis regimens are based on the nature of the exposure and modifying factors such as known resistance of the HIV strain to certain agents. The majority of HIV exposures will warrant a two drug regimen, using 2 NRTIs or 1 NRTI and 1 NtRTI and integrase inhibitor. CDC recommendation for first line combinations includes: zidovudine (ZDV) and lamivudine (3CT) and raltegravir (intergrase inhibitor).

Antiretroviral treatment is complex, involving a combination of drugs and resistance will appear rapidly if only a single drug is used. The 6 available classes of antiretroviral drugs, NRTIs, NtRTIs, NNRTIs, PIs, fusion inhibitors integrase inhibitor, CCR5 co-receptor antagonists can be combined to provide highly active antiretroviral therapy (HAART). For many (but not all) patients, HAART converts an inexorably fatal disease into a chronic disease with a fairly good prognosis.

References

Biosafety in Microbiological and Biomedical Laboratories; Deborah E. Wilson, DrPH, CBSP Director Division of Occupational Health and Safety National Institutes of Health Bethesda, Maryland L. Casey Chosewood, M.D. Director Office of Health and Safety Centers for Disease Control and Prevention Atlanta, Georgia; US Government Printing Office, Washington DC. 5th Edition; 2009

Control of Communicable Diseases Manual, 18th Edition; Heymann, David L., MD, Editor. ATHA Press.

Information from the CDC and Control and Prevention National Center for Infectious Diseases Division of Healthcare Quality Promotion and Division of Viral Hepatitis

http://www.cdc.gov/HAI/organisms/hiv/hiv.html

https://www.cdc.gov/labs/pdf/SF__19_308133-A_BMBL6_00-BOOK-WEB-final-3.pdf

A Rapid Review of Rapid HIV Antibody Tests Jeffrey L. Greenwald, et al. https://www.ncbi.nlm.nih.gov/pubmed/16524549

MMWR 2005; 54 (No. RR-9) Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Post exposure Prophylaxis

NEJM 2003; Volume 349:1091-1092 Occupational Exposure to HIV

Mayo Clinic; http://www.mayoclinic.com/health/hiv-aids/DS00005/DSECTION=treatments-and-drugs

Revised: 8/24/2012