Tattoos and ART

Tattoos have been a significant form of self-expression and body art for centuries. While tattoos are primarily known for their aesthetic appeal, there has been speculation about their potential impact on bodily functions, including sweating. Delving into the potential effects of tattoos on sweating, it is important to understand the physiological mechanisms involved. The human body possesses two primary types of sweat glands: eccrine and apocrine glands. Eccrine glands, located throughout the body, are responsible for regulating body temperature and are not influenced by tattoos. Apocrine glands, found primarily in areas with dense hair follicles, secrete sweat that is associated with emotional and stress responses, and can potentially be affected by tattoos in these areas. Several factors contribute to an individual's sweating patterns, such as age, gender, physical fitness, temperature, and emotional state. While tattoos may not directly affect sweating, they can indirectly influence the perception of sweat due to changes in skin characteristics. Tattooed skin tends to be denser and may have reduced sensitivity, potentially impacting the individual's perception of sweating.

Scientific studies investigating the impact of tattoos on sweating have yielded mixed results. Some research suggests that tattoos may impede sweat production due to the potential obstruction of sweat gland ducts by tattoo pigments. Conversely, other studies have found no significant difference in sweating between tattooed and non-tattooed individuals. These conflicting findings indicate that further research is needed to establish a correlational relationship between tattoos and sweating.

The psychological aspect of tattoos should also be considered when exploring their potential effect on sweating. Tattoos are often associated with self-confidence, body image, and personal identity. Research has shown that individuals with tattoos may experience altered perceptions of their bodies, leading to changes in self-esteem and self-perception. Such psychological factors can indirectly influence sweating by affecting an individual's response to emotional and stressful stimuli. Further research is needed to explore the potential impact of tattoos on sweating patterns comprehensively. This research should involve larger sample sizes, control groups, and standardized measurements to ensure accurate and reliable results. Understanding the interplay between tattoos and sweating will not only contribute to scientific knowledge but also aid in addressing concerns and misconceptions surrounding tattoos.

While tattoos have become a prominent form of self-expression, their influence on sweating is still not fully understood. As society's fascination with tattoos continues to grow, it is important to guide patients in the right direction for their bodies. These are not things we typically think about when getting a tattoo, but if a patient does come up with the questions, it's an important enough note to mention since sweating from the apocrine glands may hurt someone’s self esteem if they see staining through their clothing or have to constantly apply a product to prevent sweating or eliminate odor. 

Resources 

Skin Tattooing Impairs Sweating during Passive Whole Body Heating, journals.physiology.org/doi/full/10.1152/japplphysiol.00427.2019. 

Natalie Eshaghian & Donna Salib

Tattoos & Art

How beautiful are those pieces of art that we call tattoos that are engraved on our bodies. Ever stop to think about what a tattoo really is and how it may be harmful to you? Tattoos date back to 5000 BCE, and are a form of art by placing a pigment under the skin through a needle. Tattoos are growing in popularity, where over 30% of Americans have at least one tattoo on their body. The effects a tattoo has on the body still remain a topic to discuss.

Tattoos are a permanent form of art given on a person's body. Tattoos are permanent since the pigment stays in the skin by causing a break in the skin, which causes a wound and that wound then has to heal itself containing the ink with it. Eventually, the pigment slowly disappears, which causes tattoos to fade in their colors over time, and this can cause harm because there are small amounts of chemicals and metabolites released in the process within our bodies, which is caused by an enzymatic and cellular process, and can seep into our bloodstream, which in turn can cause allergies and harm to our body. (2)

Tattoos used to be mainly given in black ink, however, throughout the years other colors were created. Different colors contain different chemicals, and these chemicals can be harmful to our bodies. Red, blue and green tattoo ink have been seen to cause allergic reactions in patients, and can sometimes be more severe. This could be linked to the fact that certain ink colors contain increased bacteria in their product. (3) In addition, sensitivity to the sun is seen in people with tattoos. Infections caused by tattoos are seen to be bacterial infections, and can be antibiotic resistant due to their increase in staphylococci infections, which can lead to sepsis since the patient won’t be responding to the antibiotics properly. (2)

According to a review done, (3) there were cases of both local skin infections and systemic infections reported, which included abscesses, endocarditis, and sepsis due to tattoos. The major reports were with the severe systemic infections since they require more care, however, the local skin infections were reported less since they were more easily treated with self-limiting treatment but can turn out to become a more severe case. Long term antibiotic therapy was needed in the more severe cases, with an average of about 6 weeks of treatment needed. It was found that there were contaminants in both opened and unopened bottles of tattoo ink, which poses an issue that the ink itself may be the source of the problem. It was found that 2 of the colors tested contained aerobic mesophilic bacteria contamination. Overall, there were a total of 2 deaths found within the study due to tattoo infections. (3)

Tattoos are a way of transmitting certain diseases as well, such as HIV, hepatitis C, and other blood borne diseases. (2) Although transmission of these diseases are rare, it is still a possibility depending on the conditions the tattoo was given. In many cases, tattoos have been given in non sterile environments, where the same needle has been used among multiple different patients, such as in prisons and self given tattoos. This creates a high risk of transmission of diseases amongst these people. A trend that has been seen is called tattoo parties, where usually an unlicensed and inexperienced tattoo artist will come to a person’s home using an at home tattoo kit to give the participants at the party a tattoo. The needle is rarely sterilized and is passed amongst the many members of the party. Tattoos in prison are a huge concern as well, since these inmates are using completely non-sterile methods to give each other or themselves the tattoos. Some methods seen in prisons are using ink from pens, or soot from burning books, and using sharp utensils, such as sewing needles or even staples to give the tattoos. All of which are not sterile, and may even be passed around among the inmates. (1) This becomes an issue because many people are unaware if they or others contain any blood borne diseases, and when they use these unsterile methods of receiving a tattoo it can cause them to develop these diseases themselves as a result.

Overall, although tattoos may be a common and beautiful thing to receive, it is important to understand the risks of them and how to lower your risks. It is very easy to lower your risks of diseases by doing some research before receiving a tattoo, such as using a licensed and registered tattoo parlor, ensuring that the needles being used are sterile, as well as the ink being used is manufactured for tattoos only since those inks contain less contaminants. In addition, one should take the proper precautions to get tested prior to receiving a tattoo for any blood borne diseases, such as HIV or Hepatitis C, to protect themselves and others. If they are positive for anything, they should be taking the proper medications to protect everyone involved. Furthermore, if one develops any allergies or infections from receiving a tattoo, they should receive medical care immediately to decrease the chances of it becoming a severe issue.

References:

1. Sazzad HMS, McCredie L, Treloar C, Lloyd AR, Lafferty L. Violence and hepatitis C transmission in prison-A modified social ecological model. PLoS One. 2020;15(12):e0243106. Published 2020 Dec 1. doi:10.1371/journal.pone.0243106

https://www-ncbi-nlm-nih-gov.jerome.stjohns.edu/pmc/articles/PMC7707477/

1. Serup J, Carlsen KH, Sepehri M. Tattoo complaints and complications: diagnosis and clinical spectrum. Curr Probl Dermatol. 2015;48:48-60. doi:10.1159/000369645

https://www-karger-com.jerome.stjohns.edu/Article/FullText/369645

1. Dieckmann R, Boone I, Brockmann SO, et al. The Risk of Bacterial Infection After Tattooing. Dtsch Arztebl Int. 2016;113(40):665-671. doi:10.3238/arztebl.2016.0665

https://www-ncbi-nlm-nih-gov.jerome.stjohns.edu/pmc/articles/PMC5290255/

Tattoos are becoming more and more prevalent and mainstream in the 21st century. In fact, according to some surveys, roughly 20% of Americans have tattoos, regardless of age. To augment to that, roughly 120 million people worldwide are tattooed. As tattoos are permanent, it is essential to know exactly what are the components of this permanent ink on one’s body. Darren McGarry, the Public Relations and Communications manager at the European Commission, Joint Research Centre, hosted a panel discussion about tattoo science and policy at the European Science Open Forum (ESOF) in England in July 2016. Pigments found in tattoo inks can be repurposed from the textile, plastics, or car paint industry which not only the people being tattooed but also even the tattoo artists themselves are unaware of.

There are several unexpected skin reactions that can result from tattooing that the person getting the tattoo should be cognizant of. These examples of complications include infections, rashes which indicate an allergic reaction to a type of ink used, rashes from a temporary tattoo, rashes from a sun allergy, skin disease (re)appears (primarily occurs when the person getting the tattoo has psoriasis), magnetic resonance imaging (MRI) burn (can happen albeit is rare), and swollen lymph nodes.

It is crucial to note that unfortunately patients with certain conditions are more susceptible to tattoo complications. All of these tattoo reactions occurred in HIV patients after their antiretroviral therapy (ART) medication regimen. An allergic tattoo reaction subsequently worsened after initiation of ART in some HIV patients. The primary case report presents a forty year old woman with a seven year history of HIV infection who got tattoos of two red ink “bleeding hearts” on her chest in December 2012. In the subsequent days, redness and swelling developed at the tattoo sites. However, this was surprising as the patient had received multiple prior tattoos without complications, including one on the lower back with red ink. The tattoo eruptions on her chest remained stable over the next six months, isolated to the areas of red ink, and she did not respond to treatments from urgent care including topical silver sulfadiazine ointment, empiric oral itraconazole, and topical betamethasone dipropionate 0.05% ointment. When the discontinuation of the patient’s first oral prednisone led to a new allergic reaction within the red portion of her lower back tattoo, subsequent prednisone doses were given. A second prednisone taper was commenced, with prednisone 30 mg daily for two weeks and then followed by 20 mg daily for eight weeks, while staged surgical excision of the three tattoos was completed over 8 weeks beginning in November 2013.

In summary, surgical excision of all of the patient’s tattoos were required albeit not all of them were recently tattooed onto the patient. This is not only shocking but also quite scary. All people are at risk of allergic tattoo reactions. As this case demonstrates, HIV patients may be at increased risk of severe tattoo reactions, particularly in the context of subsequent ART initiation. As there is an increasing popularity of tattoos, patients should be made aware of the inflammatory risks that tattoo inks can pose, and, more importantly, that HIV patients may have some distinctive risk factors for possible tattoo complications.

References-

Tattoos: 7 Unexpected Skin Reactions and what to do about them. American Academy of Dermatology Association. https://www.aad.org/public/everyday-care/skin-care-basics/tattoos/tattoo-skin-reactions

Gamba, C, Smith, F, et al. Tattoo reactions in an HIV patient: Autoeczematization and progressive allergic reaction to red ink after antiretroviral therapy initiation. Journal of the American Academy of Dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809398/

Tattoos and HIV

Humans have marked their bodies with tattoos for thousands of years. These permanent designs—sometimes plain, sometimes elaborate, always personal—have served as amulets, status symbols, declarations of love, signs of religious beliefs, adornments and even forms of punishment. In modern day, getting s tattoo is slowly becoming more acceptable in professional places such as the workspace. When a person gets a tattoo, a tattoo gun which is comprised of a needle on its tip is injected into their skin. The process of getting a tattoo involves breaking the skin. As a result, the tattooed area goes through a healing process where the area gets itchy and the very 1st layer of skin peels, For the most part, tattoos are safe, especially when done at a parlor with a licensed artist. Here, health regulations are put in place by the city and state requiring sterilization, new ink, and new needles with every customer to prevent contamination.

However, there are many ways in which tattoos can be unsafe and pose many health risks. The Main one being HIV infection. First, many people receive tattoos in illegal and unsafe ways to save money. In the 1970s tattoo parties started to emerge. Basically, a tattoo party is when a bunch of people get together at someone’s house and get tattoos done by an unlicensed amateur artist with an at home tattoo kit. Additionally, prisoners have their own tattoo culture. The gun is usually comprised of a motor (dryer, fan, radio), a needle (pen, guitar string, sewing needle, staples) and ink (pens or soot from burned books). Where someone would tattoo everyone. Not only do these methods prove to be unsafe and can cause damage to one’s skin, but they are very unsanitary. Due to the sharing of needles and unsanitary conditions, many of these people contract and spread HIV, Hep C, and other blood- borne diseases, skin infections, keloids, and even end up with regrettable “art”.

Additionally, during the Aids epidemic, tattooing was band in order to try and stop the spread of HIV. Antiretroviral therapy was then developed to treat the HIV infection, but there still is no cure. These medications are used to help reduce viral load to decrease transmission and improve the patients’ symptoms. Since these medications prevent the infection from multiplying, it allows the immune system to recover and prevents the patient from developing AIDS. When a patient has an undatable viral load of less than 50 copies/ml, they have no risk of transmitting HIV. Some classes of antiretroviral therapy include nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors, CCR5 antagonists, post-attachment inhibitors, and integrase strand transfer inhibitors (INSTIs). When comprising a treatment regimen for HIV, there is usually a combination of 3 medications from at least 2 of the drug classes. Multiple regimens are available and determined by the patent’s needs and side effects. Furthermore, it is vital that a patient understands and complies with the regimen to prevent HIV transmission and drug resistance which could make certain treatments ineffective.

References:

Tattoos. Smithsonian.com. https://www.smithsonianmag.com/history/tattoos-144038580/. Published January 1, 2007. Accessed May 27, 2021.

Baeumler W: The possible health consequences of tattoos. Dtsch Arztebl Int 2016; 113: 663–4. DOI: 10.3238/arztebl.2016.0663

Tattoos have become increasingly popular. Although it may have been taboo and still is, they are certainly becoming more common. Employers in the past have been discouraging and strict with the appearance of tattoos but nowadays, people are much more open-minded and accepting of the body art. Varying in size and color, people can choose to tattoo just about any part of their body. Researchers estimate that about four in every ten young adults aged 18-29 have at least one tattoo. More than half of them have two or more as shared in source 1.

With the well-loved and expressive art there are some risks to consider when understanding the type of inks and the healing process. A needle injects ink into the skin repeatedly until the desired image is achieved. The ink is injected into the dermis, which is the layer under the epidermis as we reviewed on our first day of this rotation. The epidermis is our outer layer that shields us from pathogens in the environment, continuously shedding and replacing old skin cells as we grow. Ink that is injected in merely the epidermis would not be permanent as it would shed off. When getting a tattoo, people often wince in pain because the dermis has nerve endings and receives a blood supply. When it comes to the type of ink and whether it is black or color, there is a distinction between organic chemicals and inorganic chemicals. The organic ones contain carbon while the inorganic ones don’t. Tattoo inks can be either but patients should do an allergy test prior as a safety precaution. Inorganic inks can be black, red, yellow, white or blue and contain minerals, salts, or metal oxides. At the moment, the FDA does not regulate tattoo inks, but they are studying the health effects of tattoo inks since many people experience skin itchiness and tenderness. In some cases, people the tattoo may even become bumpy or scaly as an inflammation response. Besides the ink itself, a sterile environment with sterile tools is ideal to prevent the risk of infection. Patients should be educated on minimizing the tattooed area’s exposure as well as how to moisturize and care when the healing process is near complete.

1. https://www.sciencenewsforstudents.org/article/tattoos-good-bad-and-bumpy

More people than ever are adorning their bodies with tattoos, and even getting their first tattoo at ages younger than was typical in the past. The most common health risks associated with getting tattooed are infections and pigment toxicity. Most tattoo inks are insoluble pigments that are dispersed in water and mixed with additives like fragrances, formulants, dispersants, and preservatives. Black tattoo inks usually get their dark color from soot-related compounds (ex. carbon black) and shading additives like titanium dioxide and iron oxides. Colored tattoo inks get their colors from azo or polycyclic compounds. Such components may remain under the skin for years after the tattoo is completed. There has been a shift towards using new organic colorants in tattoo ink, but heavy metals like titanium, aluminum, and copper are still widely used. Since they are relatively new compared to the traditional tattoo inks, there is not a lot of data about their potential for dermal toxicity or long-term effects on the body. Tattoo inks may also be a source of bacteria that can be easily introduced to a compromised skin barrier even if the needle being used is sterile. When the tattoo pigment is deposited under the skin, the body becomes exposed to it forever and negative reactions to the pigment may not present until months or years later. Inflammatory reactions are not uncommon and can severely damage the skin, causing conditions like epidermal hyperplasia. Bacterial infections commonly occur when the skin, needle, and/or tattoo ink are not sterile. They can range from mild and local skin infections to more severe and systemic infections like sepsis and endocarditis. Bloodborne viruses like hepatitis B or C and HIV are also a major concern when it comes to tattoo infections. What clients can do is educate themselves on the risks of getting a tattoo, learn about what they can do to limit their risk of infection, and get a tattoo from a tattoo artist that they trust. It is going to be something that they have to live with in their bodies for the rest of their lives so taking the time to thoughtfully plan it out is only going to benefit them.

References:

1. Laux P, Tralau T, Tentschert J, et al. A medical-toxicological view of tattooing. Lancet. 2016;387(10016):395-402. doi:10.1016/S0140-6736(15)60215-X

When an individual receives a tattoo, ink is injected into their skin with the tattoo gun. This tattoo gun has small needles that puncture the skin between 50 to 3000 times a minute, as small drops of ink are deposited into the skin. When the tattoo is finished, it is considered to be an open wound that requires a certain amount of time to heal. HIV is able to get transmitted through blood, so getting a tattoo would put someone at risk for transmission of HIV due to shared needles or shared ink practices. In December of 2013, a study conducted at the Pew Research Center showed that 36% of people between the ages of 18 and 25 have at least one tattoo. There are certain health regulations put into place by each state professional parlors have to follow in order to stay open. Some of these processes include having tattooing equipment go through certain sterilization processes , replacing new ink used between every customer, and being at least 18 years of age/having parental consent when getting a tattoo.

Despite certain regulations in place, many people receive their tattoos illegally and from illegitimate tattoo parlors. Tattoo parties have become a growing fad among the youth over the last couple of years and include gatherings where party guests look to get inexpensive tattoos from unlicensed artists. These unsafe practices lead to a higher transmission risk of HIV, hepatitis C, skin infections, and other blood borne diseases. The population that is most at risk to HIV transmission from tattoos are prison inmates. Prisoners get tattoos as part of the prison culture, and for other gang related reasons. Prison inmates will often create a motor from dryers, radios, or cassette players they find laying around. They make tattoo needles from sharp objects found such as pens, guitar strings, sewing needles or even staples, and ink from local pens, or burning books that form soot. These tattooing practices are especially dangerous because none of the supplies used are sterile or meant to puncture the skin. One study has stated that about 2% of the US prison population is HIV positive and about 30 to 40% have hepatitis C, largely transmitted from unsafe tattooing practices.

If a patient was diagnosed with HIV, they would start antiretroviral therapy as soon as possible. The purpose of starting antiretroviral therapy would be to reduce their viral load as much as possible, so it doesn't become a threat to themselves or others. Certain classes of antiretroviral therapy include nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors, and integrase inhibitors. These medications either stop the virus from replicating copies of itself or stop HIV from entering the CD4 cells of the immune system. Combination HIV medications contain two or more HIV medicines from one or more drug class, and are recommended to prevent the virus from developing resistance to one or both of the medications. In most cases, HIV patients have to take these medications forever for continued reduce in viral load. On the other hand, the hepatitis C virus can be cured, and the most common treatments today include direct acting antivirals. These antivirals interfere with proteins that help the virus grow or spread, and in most cases, remove all traces of hep C from the blood within 12 weeks. Doctors look for a sustained virologic response (SVR) to tell if a patient is cured.

https://hivinfo.nih.gov/understanding-hiv/fact-sheets/fda-approved-hiv-medicines

https://www.actionwellness.org/blog/safe-ink-tattooing-and-hiv-transmission-risk/

Tattooing is the process of implanting permanent granules into the skin. A needle is used to puncture the skin and the tattoo ink is injected into the dermis. Tattoos have been around for thousands of years and they have different representations in different cultures. Tattoos are increasing in popularity especially in teenagers and young adults and there are even beauty trends such as eyebrow tattoos. There are no federal laws to promote and regulate safe tattooing and there are numerous skin complications that can come from tattoos. Microorganisms such as Staphylococci, Streptococci and Pseudomonas can contaminate tattoo inks even though it contains preservatives. Another cause of infection would be if the skin area is not disinfected properly. The third cause would be if the patient develops pruritus and burning and scratches while the tattoo is healing. Allergic reactions, systemic infections, photodermatitis, etc can occur from tattoos. An allergic reaction can occur since it is a physical injury and pigments used can also cause a reaction. There can be a reactivation of infections such as herpes. Skin diseases such as psoriasis and eczema can also result in the area where the tattoo is located. Furthermore, if a person decides to remove a tattoo through laser tattoo removal, this can also cause complications including blistering and hemorrhage. There were actually cases where benign lesions like seborrheic keratosis and epidermal cyst occur after tattooing. There were few cases of malignant lesions but true association is hard to detect. Overall, clinicians should be able to diagnose and treat patients as soon as possible. Corticosteroids can be used to treat allergic reactions, specific antibiotics can be given after bacteria culture testing, etc. Most complications can be prevented by following guidelines and strict aseptic techniques and environment. 

References 

Bäumler W. Tattoos and Their Potential Health Consequences. Dtsch Arztebl Int. 2016;113(40):663-664. doi:10.3238/arztebl.2016.0663

Khunger N, Molpariya A, Khunger A. Complications of Tattoos and Tattoo Removal: Stop and Think Before you ink. J Cutan Aesthet Surg. 2015;8(1):30-36. doi:10.4103/0974-2077.155072

The practice of adorning the body with permanent ink dates back to ancient times, and now more than ever people are getting tattoos. Today, a large proportion of the younger generation has at least one tattoo. The growing popularity of tattoos amongst the population breeds a sense of benign safety about getting one. Despite the recent popularity of tattoos, there have been consistent reports within the literature which detail the adverse reactions that occur after the injection of tattoo inks. Such reactions can occur immediately or many years down the line. The injection of foreign substances is associated with potential complications, including blood-borne viral infections (hepatitis B and C, HIV virus); superficial or systemic bacterial infections (MRSA, pseudomonas aeruginosa, and nontuberculous mycobacteria); phototoxicity, and hypersensitivity. More serious and long-term complications arising within permanent tattoos include pseudolymphomatous reactions, discoid lupus erythematosus, and malignant lesions. In addition, the migration of the tattoo ink into the lymph nodes resembles melanoma when conducting an inspection, which can then lead to unnecessary testing. Despite the popularity of tattoos, most reactions are not well-known to consumers or even licensed tattoo artists. Tattoo inks are considered cosmetic products under the United States Food and Drug Administration’s (FDA) Federal Food, Drug, and Cosmetic Act. The FDA does not test or look at pigments before they go to market, but will instead investigate only if enough people start making complaints. There are no other standardized requirements for safety testing, and enforcement of regulations is left to state and local jurisdictions. Thus, an absence of recorded assessments of tattoo ink composition and toxicology poses problems in current and evolving tattoo practices.

References

Maarouf M, Saberian C, Segal RJ, Shi VY. A New Era For Tattoos, with New Potential Complications. J Clin Aesthet Dermatol. 2019;12(2):37-38.

Written by: Denise Cotter and Niyati Doshi

When an individual decides to get something tattooed on their body the first two questions that probably come to mind are ‘what should they get?’ and ‘how painful will this be?’ People often do not realize the risk they are taking when receiving a tattoo. As time has gone on, tattoos have become more popular with 21% of adults in the United States reporting that they have at least one tattoo. Tattoos can be used to decorate the body and now we are seeing cosmetic tattooing (i.e. microblading eyebrows or tattooed eyeliner). When getting tattooed, ink is injected into their skin with a tattoo gun which contains a needle that is able to puncture the skin ~50-3000 times per minute. This action deposits the ink intradermally. Therefore, these micro punctures in the skin enable infections to occur in the bloodstream. Needles should only be used one time per person and should not be reused. If the same needle to tattoo an HIV infection individual was then used on you, this could cause the transmission of HIV.Individual at the highest risk for HIV transmission via tattoos are those in prison. Tattoo needles may be created from pens, guitar strings, sewing needles, and staples. The tattoo gun and pen used is also from things they can get their hands on in prison. While it has been difficult to determine the exact percentage of those infected through tattooing, the risk is there. Since tattoo inks are injected intradermally it is recommended that ink manufacturers produce sterile inks. Tattoo artists should avoid: using products not intended for tattooing, ink dilution, and avoid use of non sterile water to rinse equipment.

If a patient already tests positive for HIV they should seek antiretroviral treatment immediately. The primary goal of antiretroviral treatment is to prevent HIV-associated morbidity and mortality. The secondary goal is to reduce the risk of HIV transmission. HIV-infected patients have a low CD4 count but waiting for a CD4 count to decline before starting therapy increases the patient’s risk for AIDS and can lead to a shorter life expectancy than those who start ART at a higher CD4 count. There are more than 25 antiretroviral drugs that are approved for the treatment of HIV infection. These drugs fall into 6 mechanistic classes (i.e. nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), fusion inhibitors (FI), CCR5 antagonist, and integrase strand transfer inhibitors (INSTIs). Additionally, ritonavir and cobicistat are pharmacokinetic enhancers used to improve the action of the ARV drugs. There are many different regimens and various combinations used depending on the individual. It is not simply a one regimen fits all therapy. One of the most important counseling points to go over with patients is that when on antiretroviral therapy they must be adherent to their medication. Nonadherencce can cause ineffective control and lead to HIV transmission.

Reference(s):

HIV transmission. https://www.cdc.gov/hiv/basics/transmission.html

HIV treatment. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/52/when-to-start-hiv-medicines

TATTOO POWER POINT & SCRIPT

Although tattooing may have originally been part of a cultural ceremony in order to preserve one’s history, in modern times, they can be purely ornamental as well as being symbolic. As tattoos are becoming more prevalent, more scrutiny into the long term health consequences is required.

The act of tattooing involves inserting vibrating needles past the epidermis to place pigments into the dermal layer of the skin. As is the case with every other kind of injection where a foreign agent enters the body, there are associated risks. Tattoo inks may be contaminated with pathogens that can cause infections. Allergic reactions to either the color additives or the preservatives can occur. The use of non-sterile and reusable needles can promote blood-borne coinfections. However, the risks can be minimized if the tattoo artist or parlor follows the proper hygienic protocols and uses approved tattoo inks by the Food and Drug Administration (FDA) and the customer also follows appropriate hygienic practices post procedure. This may not always be the case. The risk is substantially higher in cases of illegally-obtained tattoos at “tattoo parties”, during incarceration, or unsanitary or unlicensed parlors.

Highly active antiretroviral therapy (HAART) remains the mainstay in treating HIV infections. Therapies typically include 2 nucleoside reverse transcriptase inhibitors (NRTI) along with either a non-nucleoside reverse transcriptase inhibitor (NNRTI), an integrase strand transfer inhibitor (INSTI), or a protease inhibitor (PI) with a pharmacokinetic booster (cobicistat or ritonavir). The Panel on Antiretroviral Guidelines recommends initiating ART immediately after an official diagnosis in order to maximize therapeutic efficacy in suppressing the viral load. The recommended regimens are listed as follows: bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy), dolutegravir/abacavir/lamivudine (Triumeq), dolutegravir/emtricitabine or lamivudine/tenofovir alafenamide or disoproxil, dolutegravir/lamivudine (Dovato), raltegravir/emtricitabine or lamivudine/tenofovir alafenamide or disoproxil. These combinations have established virologic efficacy, favorable tolerability and toxicity profiles, and ease of use.

Pre-exposure prophylaxis (PrEP) is also recommended for at-risk populations, such as having those having unprotected sex, the sharing needles and syringes among intravenous drug users, gay and bisexual men, and transgender women who have sex with men. Currently, two regimens are recommended: emtricitabine/tenofovir disoproxil (Truvada) and emtricitabine/tenofovir alafenamide (Descovy).

Choosing an initial therapy may prove difficult, as certain comorbidities, intolerable adverse reactions, drug-drug interactions, and difficulty of use may not only lead to regimen failure but also to higher resistance rates, which will make later treatments less effective. So readjusting therapy is very common in order to find the right balance between therapy success and all the potential risks (e.g., tenofovir alafenamide is more nephrotoxic but tenofovir disoproxil may worsen cardiovascular issues).

References

1. What to Start: Choosing an HIV Regimen Understanding HIV/AIDS. AIDSinfo. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/53/what-to-start--choosing-an-hiv-regimen. Published 2020. Accessed June 23, 2020.

2. Brief What to Start Adult and Adolescent ARV. AIDSinfo. https://aidsinfo.nih.gov/guidelines/brief-html/1/adult-and-adolescent-arv/11/what-to-start. Published 2020. Accessed June 23, 2020.