A systematic review of risk of HIV transmission through biting or spitting: implications for policy, FV Cresswell et al, HIV Medicine (2018)

In the wake of policy developments reflecting an outsized fear of HIV transmission via spit and bites (the use of "spit hoods" by police; introduction of a bill calling for increased penalties for assaults on emergency workers based on perceived risk of disease transmission), researchers in the United Kingdom performed a systematic review of all available published studies on transmission via these routes. Their conclusion, one that has been referenced repeatedly by public health officials and scientist in the U.S., is that there is no risk of HIV transmission from spitting, and that the risk through biting is negligible. Of the nine alleged incidents of HIV transmission from a bite, most occurred between family members and only four were plausible sources of transmission. In each of these four cases, the PLHIV had advanced disease, high viral load, the bites were severe and involved blood. They did not find a single case of possible transmission involving an emergency responder. The authors recommend that policies intended to protect emergency responders be consistent with this evidence. The body of research summarized in this article also it provides scientific support for elimination not only of mandatory testing following a first responder’s alleged exposure, but of laws and policies that criminalize spitting and biting by PLHIV.