What is it?

HIV and Hepatitis B and C are viral infections carried in the blood. HIV stands for Human Immunodeficiency Virus and is a virus that destroys the cells that fight off infections in the body. This causes the immune system to become ineffective, particularly against certain types of infection. As the immune system continues to weaken, patients are at risk of developing life-threatening conditions. Hepatitis B and C target the liver and can lead to cirrhosis of the liver, as well as liver cancer.

 

Causes

HIV and Hepatitis are transmitted through sexual contact, open wounds or mucous membranes exposed to infected blood, intravenous drug use, and blood transfusions (very low risk). These infections can also be passed from a mother to child during childbirth.

 

Risk Factors

Risk factors are related to the routes of transmission mentioned above. Risks include having unprotected sex, sex with multiple partners, and intravenous drug use (especially sharing of contaminated needles). Using injectable performance enhancing drugs in sports carries the risk of blood-borne infection transmission.

From a sports perspective, there is a small, theoretical risk that blood-borne infections can be transmitted from bleeding wounds or a skin injury of an infected athlete. For HIV, the theoretical risk of HIV transmission in sports is thought to be less than 1 potential transmission in 85 million games. The risk of Hepatitis B transmission is slightly higher at 1 potential transmission in 850,000-4.25 million games.

 

Symptoms

Patients infected with HIV typically develop signs of an acute illness between one and four weeks of becoming infected. Symptoms include fever, muscle aches, rash, and headaches, similar to influenza. Hepatitis B has a similar presentation but may also present with yellowing of the skin, dark colored urine, and an enlarged, tender liver. Patients who are infected with hepatitis C are more likely to have no symptoms.

 

Treatment

HIV treatment consists of a combination of medications referred to as HAART (Highly Active Antiretroviral Therapy). Hepatitis B is treated with interferon injections and oral antiviral medications. Hepatitis C is also treated with antiviral medication. An infectious disease doctor typically treats HIV. A physician specializing in treatment of liver diseases treats Hepatitis B and C.

 

Prevention

Prevention should focus on the common routes of transmission, particularly safe-sex practices and avoidance of intravenous drug use. Prevention in sports should focus on treating bleeding injuries. Proper equipment (i.e. gloves) should be used to treat bleeding injuries. Athletes that are bleeding should be removed from the event as soon as possible. Blood-contaminated jerseys should be changed promptly. Skin injuries should be covered while participating in sports until completely healed. Athletes should wear appropriate protective equipment such as mouth guards.

Hepatitis B can be prevented by vaccination, which is typically administered during routine childhood vaccines. No vaccines currently exist for HIV and Hepatitis C.

 

Return to Play

There is a very low risk of transmission of blood-borne infections during sports. Infection with HIV and Hepatitis B and C should not prevent athletes from participating in sports.

AMSSM Member Authors
Alexei DeCastro, MD and Jock Taylor, MD

References
Kordi R, Wallace WA. Blood borne infections in sport: risks of transmission, methods of prevention, and recommendations for hepatitis B vaccination. British Journal of Sports Medicine 2004;38:678-684.
Chu C, Selwyn PA. Diagnosis and initial management of acute HIV infection. American Family Physician. 2010 May 15;81(10):1239-44.