Fighting

Published: 01 October 2011
  • Transmission during fighting is extremely rare, but a few cases have been attributed to this activity.

A few cases of HIV transmission have been attributed to blood-to-blood contact as a result of fighting.

A 49-year-old man tested HIV-positive after a 'routine' insurance screening. He was married but claimed to have been impotent for ten years and never to have had sex with another man. He admitted using intravenous drugs on one occasion but was adamant that he had used a clean needle. Following the suggestion of the doctor that he had indeed contracted HIV from needle use, the man enquired whether cuts on the hands might be a route for transmission. He said that at one time he had frequented gay cruising areas with work colleagues with the intention of beating up gay men. He had frequently sustained small lacerations on his hands, and got large amounts of his victim's blood on himself. Doctors noticed recently scabbed lacerations on his hands said to result from a recent fight.1 However, there is also the possibility that this man lied about his sexual risk factors.

A case was reported where a man was diagnosed HIV-positive following a blood donation. His only risk was identified as a fight involving injuries and profuse bleeding with a man at a wedding reception who was HIV-positive.2 3 Ten days later the man was hospitalised with nausea, sore throat, diarrhoea and rash. The blood samples taken during his hospital stay were subsequently tested for HIV, and seroconversion was shown to have occurred approximately two weeks after the onset of the illness. However, viral sequences from the two men were not compared.

In the next case, viral sequences were not compared either, as there were no stored samples from the presumed source, who died one year after the fight. Two men, one of whom had previously been diagnosed with HIV, had a bloody fight in 1991.3 Four days after the fight, the previously undiagnosed man complained of lethargy and headaches, and two months later was hospitalised with what appeared to be HIV encephalitis. An HIV antibody test was positive. Given the fact that the man he had fought died one year later, it is likely that he had a very high viral load at the time of the fight.

In a 1992 case from the USA, a previously uninfected man had a violent fight with his brother (who had an AIDS diagnosis). He attacked his brother by repeatedly banging his forehead against the brother's face and forehead, which resulted in a nasal haemorrhage in the HIV-positive man and wounds in both. The man tested antibody negative immediately after the fight, but was positive one month later. Although the two men shared a house, they were reported not to share items like razors or toothbrushes, or have a sexual partner in common.4

There may have been a transmission after a similar injury following a sporting accident.5 A man bashed his head against another man's head during a football match. Blood was seemingly exchanged, but there are doubts over the documentation of the report, and there are suggestions that the man may have had other risk factors. (This is the only suspected case of HIV transmission during sporting activities.)6

A more recent case was reported from Belfast in 2008. A man with one lifetime sexual partner and no other risk factors had a drunken, bloody fight with his brother, who was HIV-positive, taking combination therapy and had a viral load of 4800 copies/ml at the time. Four weeks later the first man complained of flu-like symptoms, and subsequently tested HIV-positive. Phylogenetic analysis showed that each man's virus belonged to subtype C, the most prevalent in heterosexuals in southern Africa (where the man's brother had originally been infected). Moreover three pol sequences were closely related to one another, but not closely related to any others sequenced at the laboratory.7

In 2011, clinicians in Taiwan described a case of HIV transmission due to a knife fight, the first ever reported in the scientific literature. A 42-year-old man, armed with a knife, attempted to rob a 69-year-old man. The older man fought back and both men were seriously wounded, with likely blood-to-blood contact. The attacker had been diagnosed with HIV three years previously, was not taking treatment and had a viral load of 57,500 copies/ml. Five months after the attack, the victim was diagnosed with HIV. Both men were infected with the same HIV subtype, while phylogenetic analysis of the env and pol regions showed that the virus in the two individuals was very closely related. Moreover, the results from incidence tests (which distinguish recent infection from established infection) suggested that the victim’s infection was recent.8

References

  1. Carson P Gay bashing as possible risk for HIV infection. Lancet 337 (8743): 731, 1991
  2. O'Farrell et al. Transmission of HIV–1 infection after a fight. Lancet 239: 246, 1992
  3. Gilbart VL et al. Unusual HIV transmissions through blood contact: analysis of cases reported in the United Kingdom to December 1997. Commun Dis Public Health 1:108-113, 1998
  4. Ippolito G et al. Transmission of zidovudine-resistant HIV during a bloody fight. JAMA 272:432, 1994
  5. Torre D et al. Transmission of HIV-1 infection via sports injury. Lancet 335:1105, 1990
  6. Kordi R et al. Blood borne infections in sport: risk of transmission, methods of prevention, and recommendations for hepatitis B vaccination. Br J Sports Med 38:678-684, 2004
  7. Emerson C et al. Transmission of HIV-1 infection due to a fist fight. Int J STD AIDS 19:131-132, 2008
  8. Kao C-F et al. An uncommon case of HIV-1 transmission due to a knife fight. AIDS Research and Human Retroviruses 27: 115-122, 2011
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.