HIV and it's role in sport

People afflicted with the human immunodeficiency virus (HIV) are becoming increasingly prevalent in society. This naturally includes active sporting individuals. The result of HIV infection, the acquired immune deficiency syndrome (AIDS) has an effect on ones ability to perform exercise, and physical activity may play an important role in the management of HIV as the disease progresses.

Risk of HIV transmission during sports participation
HIV infection is spread by contact with tissue fluids from an infected individual. This may occur during sexual intercourse or as a result of contact with blood or blood products. There is a potential risk of the HIV being transmitted during sporting activities, if blood from an infected individual makes contact with an open wound on an uninfected individual. The risk in a particular sport is determined by the seroprevalence of HIV infection in the participants of that sport, the risk of open wounds, the risk of viral transfer should blood make contact with another players wound and the risk of two players making contact.

Testing of sport participants
Compulsory testing is controversial as this may impact on an individuals democratic rights and their employment rights in professional sport. This testing can only be performed if informed consent is given. Unless expensive, virus specific testing is performed, testing does not guarantee safety. As routine testing does not provide sufficient guarantee against possible transmission of HIV, such testing cannot be recommended and SASMA does not advise compulsory testing in sport.

Prevention guidelines
The best protection from possible HIV infection is to primarily address lifestyle changes and then secondarily to make use of barrier methods when in contact with tissue fluids. SASMA adopts the following general and specific guidelines for sports participants, coaches, officials and medical staff to decrease the risk of transmission of HIV.

General guidelines
In general the risk of transmission of HIV as a result of playing sport is relatively low.
The risk is higher in sports with a higher risk of contact between players and where there is a higher risk of open bleeding wounds. Education about the disease is still essential in the prevention of HIV. It is recommended that individuals who have HIV disclose their status to the medical personnel responsible for the care of a team. This information must be held in the strictest confidentiality.

Specific guidelines
Sports participants with known HIV infection should seek medical counselling before considering further participation, in order to assess the risks to their own health as well as the risk of HIV transmission to other sports participants. The primary responsibility lies with the individual not to expose a competitor to the risk of transmitting HIV.

Wound management
All medical personnel should make use of universal precautionary measures at all times to prevent transmission of HIV to themselves and other participants, irrespective of whether a participants HIV status is known or not. It is essential that the medical staff should be notified as soon as a participant sustains an open bleeding wound on the field so that the wound can be managed appropriately. All open skin lesions sustained during sporting activities should be treated appropriately before allowing a player to return to the playing field. Wounds should be cleaned with a suitable antiseptic such as hypochloride, gluteraldehyde, organic iodines or alcohol. Once clean, wounds should be covered so that there is no risk of exposure to blood on returning to the playing field. Appropriate disposal of all blood-contaminated and sharp articles must be ensured.

The effect of physical activity on HIV infection
Regular physical activity seems to be safe and beneficial for most individuals with HIV disease. Regular participation in moderate intensity aerobic activity (60-80% of maximum heart rate) results in an improved immune function. Aerobic and progressive resistance exercise programs can improve skeletal muscle mass and function, mood state and endurance capacity. These changes may result in an improved quality of life for the HIV positive individual. Exercise thus offers an additional therapeutic technique for the management of HIV infected individuals. The long-term effects of acute high intensity exercise or repeated exercise to exhaustion in people who have HIV infection are not known and it is thus advised that such forms of exercise be avoided.

The effect of HIV on sporting performance
There is no scientific evidence that an asymptomatic person is unfit to play sport. The physiological responses to exercise in such asymptomatic individuals are unaltered. However, exercise performance and the training response is impaired in patients with more advanced HIV disease. Patients infected with HIV should be advised to undertake a complete physical examination and to gain medical clearance prior to commencement of an exercise program. The prescription of an exercise program should be individualised, integrating the physical fitness of the patient, the stage of HIV disease and concomitant medication used. Physical activity programs should be initiated early, while the patient is still asymptomatic. Other support in the form of nutritional and psychological counselling should also be included in the complete management of the patient.

Suggested reading
1. Mars M. HIV infection and exercise. South African Journal of Sports Medicine 2000; 7:3-10.

South African Sports Medicine Association