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HIV Prevention (Expert Forum)
New oral risk question.
Answered by
Edward W Hook, MD - HIV Prevention, stds
This forum is limited to prevention of HIV and to safe sex in general. If you believe you might have been exposed to HIV and want help to judge your risk, would like advice about HIV testing, or have questions about the effectiveness of condoms or the risks associated with specific sexual practices, this is the site for you.
IMPORTANT
No questions will be accepted on the treatment of HIV/AIDS or its complications, viral load, and similar topics. If you have questions about a specific STD other than HIV/AIDS, please visit the STD Forum. Questions that do not pertain to the above topics will be removed from the forum.
If you have not done so, please review other threads in our archives for questions similar to yours and Dr. Handsfield's replies. Questions that duplicate other frequent ones, for which abundant replies exist, and that have little educational value for other forum users, will be DELETED WITHOUT RESPONSE. YOUR PAYMENT WILL NOT BE REFUNDED. The most common examples of such questions are those about low risk exposures to HIV, such as oral sex, condom- protected intercourse hand-to-genital exposure, and nonsexual contact with possibly infected blood or body fluids as well as symptoms of early HIV infection.
No questions will be accepted on the treatment of HIV/AIDS or its complications, viral load, and similar topics. If you have questions about a specific STD other than HIV/AIDS, please visit the STD Forum. Questions that do not pertain to the above topics will be removed from the forum.
If you have not done so, please review other threads in our archives for questions similar to yours and Dr. Handsfield's replies. Questions that duplicate other frequent ones, for which abundant replies exist, and that have little educational value for other forum users, will be DELETED WITHOUT RESPONSE. YOUR PAYMENT WILL NOT BE REFUNDED. The most common examples of such questions are those about low risk exposures to HIV, such as oral sex, condom- protected intercourse hand-to-genital exposure, and nonsexual contact with possibly infected blood or body fluids as well as symptoms of early HIV infection.
New oral risk question.
by annierae, Jun 22, 2008 12:13PM
Hi,
I couldn't find any information on the forums to answer this, so I thought I would post it as a new question.
I was reading the public forums last night and came across a post that got me thinking and freaked me out a bit. I read up a bit on it, and a few studies are now suggesting that alcohol before an oral sex exposure can increase your risk of getting HIV. One study apparently suggested that alcohol makes your epithelial cells more susceptible (mind you it was with only a sample size of 8 subjects), and another suggests (albeit the subjects drank 12-16 drinks) that drinking alcohol kills/inactivates the protective enzymes and proteins of your mouth, decreasing your defenses against pathogens. I know when you drink alcohol that the alcohol levels are the same as in blood, and that HIV is a very weak virus, so in your opinion, do you think that if someone casually had a few drinks before giving oral sex that it would put them at a significant risk? My thoughts are that if the alcohol in your saliva is strong enough to kill salivary proteins/enzymes, that it would surely function to kill HIV as well. If it wasn't at levels high enough to kill HIV, then it probably wouldn't pose any significant decrease in immune defense at least no noticible effect).
I suppose that with all of the millions of cases of oral sex, a great deal of them were probably done with alcohol pre-exposure and no association/case reports even suggest it as a risk factor (as far as inactivating bodily defenses), so would it be safe to assume that this is no cause for increased worry whatsoever?
Thanks for all the amazing work you guys do!
I know I'm probably worrying about nothing, but I'm sure others have the same concerns and would love to hear your opinion on this matter.
I couldn't find any information on the forums to answer this, so I thought I would post it as a new question.
I was reading the public forums last night and came across a post that got me thinking and freaked me out a bit. I read up a bit on it, and a few studies are now suggesting that alcohol before an oral sex exposure can increase your risk of getting HIV. One study apparently suggested that alcohol makes your epithelial cells more susceptible (mind you it was with only a sample size of 8 subjects), and another suggests (albeit the subjects drank 12-16 drinks) that drinking alcohol kills/inactivates the protective enzymes and proteins of your mouth, decreasing your defenses against pathogens. I know when you drink alcohol that the alcohol levels are the same as in blood, and that HIV is a very weak virus, so in your opinion, do you think that if someone casually had a few drinks before giving oral sex that it would put them at a significant risk? My thoughts are that if the alcohol in your saliva is strong enough to kill salivary proteins/enzymes, that it would surely function to kill HIV as well. If it wasn't at levels high enough to kill HIV, then it probably wouldn't pose any significant decrease in immune defense at least no noticible effect).
I suppose that with all of the millions of cases of oral sex, a great deal of them were probably done with alcohol pre-exposure and no association/case reports even suggest it as a risk factor (as far as inactivating bodily defenses), so would it be safe to assume that this is no cause for increased worry whatsoever?
Thanks for all the amazing work you guys do!
I know I'm probably worrying about nothing, but I'm sure others have the same concerns and would love to hear your opinion on this matter.
Doctor's Answer
by Edward W Hook, MD, Jun 22, 2008 01:28PM
, Jun 22, 2008 01:28PM
The levels of alcohol required to kill either viruses or human cells are far above the levels of alcohol that most humans can tolerate. Thus while alcohol can inactivate (denature) enymes (proteing) this is not a practical or realistic concern. In additon certain types of cells are more easily affected by alcohol than others. The most vulnerable cells include nerves cells and liver cells. Epithelial cells (skin. mucous membrance on the other hand are far more resistant. Thus the idea that alcohol ingestion might significantly protect from (through killing the virus) or enhance the probability (through damaging cells or inactivating antibodies or enzymes) of infection is not a practical concern.
Persons who ingest alcohol chronicly, to the point of true alcoholism, can become more susceptible to disease as the result of chronic damage by alcohol to the liver of other organs which play a role in host defense. To do this hwoever, persons are typically in the late, end stages of alcoholism.
Most experts believe that the main way that alcohol effects HIV/STD risk is through the effect on decison making or dexterity (i.e. improper condom use, etc). EWH
Persons who ingest alcohol chronicly, to the point of true alcoholism, can become more susceptible to disease as the result of chronic damage by alcohol to the liver of other organs which play a role in host defense. To do this hwoever, persons are typically in the late, end stages of alcoholism.
Most experts believe that the main way that alcohol effects HIV/STD risk is through the effect on decison making or dexterity (i.e. improper condom use, etc). EWH
Thanks for the comments! I was assuming that either the benefit or damage in fighting off HIV orally was either nonexistent or insignificant. I had consumed a few drinks (bet. 2-3) before engaging in oral sex, but was not impaired in any major way. So basically what your saying is that even if a slight bit of alcohol was in my saliva, it would not be enough to denature proteins/enzymes in any major way as to increase my risk? Or if some of the salivary enzymes / proteins were degraded, it would not be a significant amount with only a few drinks? I was worried that alcohol somehow would prevent the production of salivary enzymes and proteins and render my salivary defenses useless (like destroy ALL/MOST of the enzymes/proteins being produced, putting me at an increased risk of HIV transmission, or am I being overly dramatic? Would such a decrease from only a few drinks be so minimal (if at all) that I wouldn't be immunosuppressed or at any increased risk scale?
I know from reading the forums that I have a virtually zero risk exposure (oral sex with a guy with no ejaculation that told me he was HIV- and had recent STD testing 1/2 a year ago), so I think I am just grasping at straws of anxiety here. I was told that the only way I would be at risk would be in a freak atypical accident such as with oral surgery or meth mouth, so I was just wanting to make sure that alcohol exposure didn't factor me into one of those atypical freak accidents (although when I think of it I suppose it hasn't been noted as a risk factor and millions of people probably drink before oral sex).
I guess it's now safe to move on and realize that this doesn't count as an "atypical situation" and doesn't change my situation of risk whatsoever (I've been told by a doctor that I have zero risk overall). I just hadn't thought of this as a risk factor before, but I guess it's not significant enough either way to count. Anxiety can make you think crazy things and I was just terrified that it put me at a realistic increased risk (like the alcohol in my mouth killed off the majority of my defenses).
http://www.jrussellshealth.org/alcimm.html
Or would the risk of a few drinks be negligible and NOT have denatured all of my oral protection and made me susceptible? I know you said it's not a practical or realistic concern, but all of this research is freaking me out. Would I not have been immunocompromised from the alcohol in my saliva?
Dr Hooks answer is great, however it seems to me it would be an easy thing the find out if hard liquor would kill the virus but then we all would be carring a flask around.