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Author Topic: oral transmission  (Read 4611 times)

0 Members and 2 Guests are viewing this topic.

Offline chaton

  • Member
  • Posts: 9
oral transmission
« on: June 28, 2006, 11:36:37 AM »
Hello

I have read many answers on this issue and I believe there are some misconceptions in the way one can read results on serodiscordant couples that need addressing.

When a statistical analysis is performed, say of transmission frequency, the result is expressed as a confidence interval for a given probability of being right (eg 95%). So what these 3 studies prove is that 0 is one of the bounds of the confidence interval, ie that the null hypothesis "oral transmission of HIV never happens" is not disproved.

What these studies cannot prove is the hypothesis "oral transmission of HIV never happens"

In fact here we are dealing with statistical analysis of rare events. Longitudinal studies are not good at estimating the probability of rare events. Take another example : follow 1000 people for 10 years. If not one dies from a thunderbold, you cannot conclude from these longitudinal studies that death from thunderbolds do not happen. It would be invidious to assert that there is only unscientific, anecdotal evidence that cannot be accepted.

What we do instead is that we examine people that have died from thunderbolts and come with an extremely low frequency over the population as a whole of dying that way. And we can do the same for oral transmission of HIV. I feel that aidsmeds should at this point accept that and state that it does happen, if very rarely.

There are further issues to address. If oral transmission of HIV is only possible when virus load is extremely high, say between the third and sixth week after infection, then almost all observations made in the studies would be irrelevant. We're dealing with couples in which the positive partner has a viral charge of less than 500 000 copies, in all or almost all observation points, presumably, so the hypothesis "oral transmission of HIV happens with a 5% (or 1% or 10%) likelihood  when ejaculates contains more than 500 000 copies" has hardly been tested in these longitudinal studies.

What I think is warranted is the following : oral transmission of HIV happens very rarely. 3 studies of serodiscordant couples have shown no case of transmission. However there are isolated documented cases. It is likely that the very low odds of transmission increase when highly contaminant semen is swallowed (which reached the highest concentration in the second month of infection of the insertive partner) and when the receiving partner has cuts or sores in the mouth (even from invisible cuts that come from flossing or aggressive brushing)


Offline Andy Velez

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  • Posts: 24,560
Re: oral transmission
« Reply #1 on: June 28, 2006, 11:44:26 AM »
Anytime you have sex with someone other than yourself there is potentially risk involved.

We don't say transmission cannot happen orally. What we say is that thus far from the evidence in over 25 years of the epidemic, only a minicule number have occured and even those are questionable because of other factors involved. So, could transmission happen orally? Yes. Does it happen? The evidence is that it doesn't.

You're entitled to add your caveat, and each person has to make a decision as to what they're comfortable doing in terms of actual risk v theoretical.

In your quest for a more exact answer I would suggest you have to be careful you do not unduly alarm readers who are in many cases already in an anxious state over something that wasn't really risky to begin with.

The bottom line is to be well educated about the issues and then make informed choices.

Cheers,

Andy Velez

Offline chaton

  • Member
  • Posts: 9
Re: oral transmission
« Reply #2 on: June 28, 2006, 12:43:53 PM »
I just feel that some aidsmeds answers on oral transmission are ever so slightly misleading. They are based on dismissing all reported cases as unproven, unreliable, or unscientific. The Lancet published last year a case study on transmission via a bloody fight: rare things happen, and isolated cases are just that.

Saying that there is no evidence is not true. You can say that there is evidence outside of longitudinal studies, but that aidsmeds disputes it.

I understand the risk of unduly alarming readers about transmission routes that are very low odds. But one should not on that basis distort the record and say there are no odds. One has to balance the risk of dispensing information which would lead to some being contaminated based on wrong assurances given by aidsmeds. One case would be one too many.

That's why I think aidsmeds should just say that odds are very very small and leave it at that. These longitudinal studies have been excessively relied upon and do not really address the issue of contamination by insertive partners in the period where there are more contaminant by several orders of magnitude. For people who can give several blowjobs in a month to unknown, highly sexually active partners in backrooms, the risk is small but not nil.

Regards

Offline Andy Velez

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Re: oral transmission
« Reply #3 on: June 28, 2006, 06:44:48 PM »
Point taken. And we don't say there isn't any risk in giving oral.

But I don't really want to go back and forth on this.

I know we're committed to being very careful about what we say here. If you check through some of the threads you will again and again see mentions of the need to decide about one's personal comfort level in terms of deciding about giving oral m2m. 
Andy Velez

Offline Consumed

  • Member
  • Posts: 73
Re: oral transmission
« Reply #4 on: June 28, 2006, 06:49:02 PM »
The problem with all of it is telling the truth. How do we know the person involved in that fight wasn't of high risk group and is ashamed to admit it? We don't. Is it possible he got it from high risk sex? Yup. could he have gotten it from that fight? Yup. Do we realy know the truth? Nope.

I think the object is live your life safe, but live it.
LYS

Offline chaton

  • Member
  • Posts: 9
Re: oral transmission
« Reply #5 on: June 29, 2006, 01:51:06 PM »
In this case published in the Lancet there was a precise match of the strains, backed by an estimate of infection time thanks to a detuned assay and viral load reverse time to infection measure. Idle hearsay does not make it into the Lancet

Offline RapidRod

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Re: oral transmission
« Reply #6 on: June 29, 2006, 01:56:48 PM »
Just because it was a match on the strain and viral load does not give conclusive results of being from oral sex. The Lancet is only giving the information that was given to them by the persons involved.

Offline chaton

  • Member
  • Posts: 9
Re: oral transmission
« Reply #7 on: June 30, 2006, 05:21:58 AM »
You're mistaken on two counts

1/ this is a documented case of transmission via bloodbath, not blowjob
2/ we're talking about the premier journal of medicine, and a full fledged case study. The Lancet is not just giving the information given to them by the persons involved but published a full biological exploration (ie pages of biological markers and advanced tests) of the contamination and its route

There is at work whiffs of denial which are detrimental to the very good work done generally by aidsmeds regulars. Some transmission routes do not happen : one cannot get HIV through a mosquito, masturbation, sharing cutlery,etc. But some routes happen, if very rarely: bloodfight, giving a blowjob.

Longitudnal studies of serodiscordant couples show that the risk of getting HIV from a partner who has been seropositive for a little time is vanishingly small (although even here there is a caveat because of survivor bias in the samples taken). These studies do not address the issue of oral transmission from partners who may still be seronegative. It has long been surmised that the dynamics of the epidemics depend disproportionately on the very recently infected, who have extremely high viral loads.

Hence my contention that aidsmeds should cease to extrapolate so much from the result of these studies (this indeed is NOT good science) and simply state that the risk of oral transmission is very very small.

Regards

Offline Matty the Damned

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  • Ninja Please
Re: oral transmission
« Reply #8 on: June 30, 2006, 05:24:21 AM »
I think you've made your point Chaton. I fail to see how continuing this conversation in Am I Infected? serves any useful purpose.

MtD
(Who disagrees strongly with Chaton)

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: oral transmission
« Reply #9 on: June 30, 2006, 06:00:51 AM »
Chaton,

We have a very simple bottom line here - anyone who is sexually active should be screened for ALL sexually transmitted infections, including but not limited to hiv, at least once a year. If you're very active with several partners, twice a year is probably best.

We do say that giving a blowjob is very, very low risk. I don't understand what your problem is. Or are you just enjoying stirring the pot?

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline ScienceGuy25

  • Member
  • Posts: 120
Re: oral transmission
« Reply #10 on: June 30, 2006, 08:53:32 AM »
Chaton

I don't really see what your argument is here.  Being in biomedical sciences myself, i believe the information given out here is extremely accurate.  The advice i've seen here from the moderator's is that as more information pours in the likelihood of contracting HIV from receptive oral sex seems extremely rare.  They have never said that it does not happen, they consistently admit that there is a very small chance that it could happen.  According to any studies out there, this seems to be the case. 

Additionally you only sight the Spain study.  I believe it was some by the name of Dr. Shafer who look at a very small cohort of men in San Fransico and followed them for a brief time, noting that none of them seroconverted after a certain number of episodes of receptive oral sex.  I think the average was 2 or 3 "casual" partners.

Furthermore you seem reasonably knowledgeable in the field of science and I agree that the Lancet study published a good report of a VERY rare event.  However, you should know that just because it is published in clinical journals such as Lancet or NEJM or their basic science counterparts like Nature or Science does not mean they are the holy grail. One of the first classes i took working on my dissertation was reading INCORRECT papers published in high impact journals such as these.

By the way where did that stem cell guy from South Korea publish?? You remember the guy with completely fabricated data - i think he made it into some high impact journals.

Bottom line is what all these guys have been saying.  Receptive oral sex is not with out risk, however from all available data, it appears to be extremely low risk.

Offline jkinatl2

  • Member
  • Posts: 6,007
  • Doo. Dah. Dipp-ity.
Re: oral transmission
« Reply #11 on: June 30, 2006, 09:11:29 AM »
Again, the plural of anecdote is not data.

And this is NOT being dismissive of the patient report studies. Were I dismissive of them, I would emphatically state that oral sex presents no quantifiable HIV risk. I do not. I concede that there seems to be a possibility for infection via this route, but it is exceedingly small. Just like the "thunderclap" analogy used in the first post on this thread.

I am rather proud of this forum's ability to make rational and science-based risk assessment. I am proud of it's foundation in first-tiered peer reviewed science.

And I for one am not about to inflate a risk which has proven to be so vanishingly small as to be currently unquantifiable, simply to assist someone else with an agenda. And the OP in this thread seems to have one.

Bloody fights? Rare indeed to get HIV through such a situation. Rare enough that any quantifiable transmission through such a vector is worthy of deep scientific scrutiny and study.

Receiving oral sex? Again, a vanishingly small risk. But even though the THREE serodiscordant couple/HOT studies by Romero, Shaffer, and others have yet to quantify the transmission vector, we err on the side of caution and state that it is low, but not no risk. And we emphatically state that people should examine the science and go with the level of negotiated risk with which they are most comfortable.

That's what we have always said.

It seems that we are being dragged through the collective coals for something we simply did not - and do not - do.

The information on aidsmeds.com is some of the most recent, most accurate, and best researched available. I for one am proud of the risk assessment here, and the LESSONS in transmission remain one of the best written and best researched pieces of information outside of a medical journal.

« Last Edit: June 30, 2006, 09:13:21 AM by jkinatl2 »
"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

-Kimberly Page-Shafer, PhD, MPH

Welcome Thread

Offline Ann

  • Administrator
  • Member
  • Posts: 28,140
  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: oral transmission
« Reply #12 on: June 30, 2006, 10:33:15 AM »


And like I said, the bottom line is everyone who is sexually active should have regular sexual health care check-ups. If more people did this, we wouldn't have people finding out they are hiv positive after they've already been infected for years and find out only when they've collapsed with PCP.

Regular testing... it's the only way. Your hiv status is nothing to guess or assume anything about.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

 


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