How does HIV spread?

Question

Hello doctor,

One of my very close friends is HIV (human immunodeficiency virus) positive. He has been under treatment for the last year. Viral load is reduced drastically but not undetectable. Yesterday we both went to a party and drank beer. I drank his beer, which he sipped, and we shared drinks and food with the same glass, spoon, and plates.

Now, I am very much afraid of HIV. We are both very close, so I cannot avoid sharing food or drink in the same utensils with him, but later, I feel very afraid or anxious.

Is it possible to spread HIV through sharing drinks or food in the same utensils?

I am daily worrying about these things, and I do not know how to overcome these fears.

Many times, I have taken HIV tests, and it is negative, but the fear starts soon after sharing any food and drinks with him.

Kindly let me know the solution.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Human immunodeficiency virus (HIV) attacks the body’s immune system. Acquired immunodeficiency syndrome (AIDS) occurs at the most advanced stage of infection. HIV targets the body’s white blood cells, weakening the immune system. This makes it easier to get sick with diseases like tuberculosis, infections, and some cancers.

HIV is spread from the body fluids of an infected person, including blood, breast milk, semen, and vaginal fluids. It can also spread from a mother to her baby. It is not spread, however, by kisses, hugs, or sharing food.

As per 2024 HIV guidelines, more details of key aspects of HIV guidelines and prevention:

HIV transmission and prevention:

How HIV spreads: HIV is transmitted through contact with infected bodily fluids like blood, semen, vaginal fluids, and breast milk.

Situations where HIV is not transmitted:

HIV is not transmitted through casual contact like shaking hands, hugging, or sharing utensils.
Hence, from your clinical history, you are unlikely to get HIV spread from sharing food with your friend in the same utensils, etc.
It is also recommended that considering your age, and social activities, you should consider using pre-exposure prophylaxis anti-HIV medicines, which would help protect you from unwarranted exposure.

As per H2024 HIV treatment guidelines33

PrEP (pre-exposure prophylaxis): Antiretroviral drugs are taken by people without HIV to prevent infection when at high risk of exposure. It is part of the comprehensive HIV prevention plan that includes discussing how to take PrEP as prescribed, proper condom use, screening for other sexually transmitted infections (STIs), and other risk-reduction methods.

There are 3 FDA-approved PrEP medications available to be taken under direct guidance:

Oral - 2 regimens:

Tablet Emtricitabine (E) 200 mg in combination with oral Tenofovir disoproxil fumarate (TDF) 300 mg.
Emtricitabine (E) 200 mg in combination with Tenofovir alafenamide (TAF) 25 mg.
Daily oral PrEP with E/TAF or E/TDF is recommended to prevent HIV through sexual transmission (and injection drug use risk factors - E/TDF).
However, it excludes people likely to get HIV through receptive vaginal sex.

Injectable:

Cabotegravir (CAB) 600 mg injection.
CAB is given as an intramuscular injection. CAB for PrEP is started by administering the first injection followed by a second injection one month after the first. CAB injections are given every two months thereafter.

Safety- PrEP has not caused serious short- or medium-term safety concerns. PrEP medications should be prescribed only to patients without severe kidney impairment. Co-administer oral PrEP with care in patients taking other drugs eliminated by the kidneys.

Therapeutic PrEP drug levels in the blood: Based on existing research, oral PrEP reaches maximum drug levels associated with protection from HIV for receptive anal sex at about 7 days of daily use. For receptive vaginal sex and injection drug use, oral PrEP reaches maximum drug levels at up to about 21 days of daily use. There are no data available about how long it takes for PrEP to reach protective levels for insertive vaginal and anal sex.

Monitoring on PrEP:

Oral - Every 3 months.
Repeat HIV antigen or antibody and HIV-1 RNA (ribonucleic acid) tests and assess for signs or symptoms of acute HIV infection to confirm that patients do not have HIV.
Every six months at least - Monitor kidney function.
Injectable PrEP: Every one to two months- Test for HIV with antigen/antibody and HIV-1 RNA assays and assess for signs or symptoms of acute infection.

Other important points for your understanding are given below:

Undetectable Viral Load: People with HIV who take ART (antiretroviral therapy)as prescribed and achieve and maintain an undetectable viral load have effectively no risk of transmitting the virus sexually.
Condoms: Consistent and correct condom use during sexual activity is a crucial way to prevent HIV transmission.
Testing: Regular HIV testing is essential for early diagnosis and access to treatment and prevention options.

Hence, please follow the above measures and take PrEP to reduce the risk of transmission of HIV from sexual exposure over a long time.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com.

Your supposed contact with your HIV-positive friend where foods have been shared is not considered as risky for HIV transmission.

As far as PrEP is concerned, it is up to you to decide on the possible risk. For implementation, you need to be under a local doctor's consultation. PrEP helps prevent lateral transmission between the infected and exposed uninfected. If there are no risk factors such as kidney function abnormality, etc., then there is no harm in starting PrEP under prescriber supervision. The duration of treatment varies with the individual.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.