Is HIV prophylaxis required in all patients with human bites?

Report By: Tanzeem Iqbal - Medical Student
Search checked by Dr Bernard Foex - Consultant A & E
Institution: Manchester Royal Infirmary
Date Submitted: 5th July 2005
Last Modified: 14th July 2005
Status: Blue (submitted but not checked)

Three Part Question

In [all patients who have sustained a human bite] is [HIV prophylaxis] required [to prevent the risk of HIV infection]?

Clinical Scenario

A 35 year old prison guard was brought into the emergency department after being bitten by a HIV- positive inmate 4 hours ago. There was a superficial laceration wound on his right leg that bled profusely when bitten. You wonder whether he will benefit from HIV prophylaxis.

Search Strategy

(MEDLINE - 1966 -06/05) and (EMBASE 1988 - 06/05)
Human bite$ .mp. or exp Bites, Human/ AND [exp Anti-HIV Agents/ or exp HIV Infections/ or HIV prophylaxis.mp. or exp Acquired Immunodeficiency Syndrome/ OR infection risk.mp. or exp HIV Infections/] LIMIT to human AND english language.

Search Outcome

EMBASE - 66 papers and MEDLINE -57 papers of which none were relevant to the original question.

Comment(s)

No relevant papers, RCTs or meta-analyses were found apart from case reports. Blood contaminated saliva may contain HIV. HIV is known to be transmitted in saliva but the risk is reported to be small. However, if blood was present in the saliva of the biters mouth, the theoretical risk is high.Trials cannot be done and therefore the question remains unanswered.

Clinical Bottom Line

Treat on clinical judgement.