New oral risk question.

[annierae]

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.

[badday103]

Thanks guys i guess I just let my anxiety disorder get the better of me when I read something that I never heard about before.  

[Edward W Hook, MD]

All:

Please see note from nursegirl above she has summarised things quite well.  This forum is not for this discussion.  The question has been addressed.  If you wish to continue these musings, please take it to the HIV Prevention Communiity.  Furthe comments on this site will be deleted.  EWH

[nursegirl6572]

The post is being deleted because these are anxiety-driven topics.  The possible etoh-related increased or decreased risk is so minimal it isn't even negligible....not to mention a lot of this info is unvalidated.

Bottom line is...stop reading on the internet...you can find any and everything you could imagine.  Doesn't make it true, or important.

[Thomas96]

I highly doubt it would make these activities risky.  Like the doc said the main thing with alcohol is that people tend to make unsafe descisions.  kissing and receiving oral are not risky and are not unsafe descisions.  Remember alcohol and hiv have been around together for a long time.  If it was helping people get hiv we would know by now.  Bottom line... Where condoms for vaginal and anal sex,  if you do perform oral dont get fluids in your mouth, and dont shoot drugs,  dont worry about a few drinks.

[longone]

This was an excellent question. I read the same report. I have also read that hard liquor 80 proof would inactivate the virus but I have been unable to fine any other supporting articles.  Most all people who engage in casual sex have been drinking.

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.

[annierae]

I need to stop reading journal articles, etc. I know I had what I've been told is a zero risk exposure, but the following website I read states that even a single, moderate amount of alcohol would render my immune system compromised:
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?

[annierae]

Okay, thanks again.
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).

[Edward W Hook, MD]

I agree that this question is a bit of a stretch.. This was a virtually no risk exposure.  EWH

[annierae]

Dr Hook,
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).

[Edward W Hook, MD]

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