Human Immunodeficiency Virus (HIV)

Characteristics
Morphology	A member of the Retroviridae family, genus Lentivirus. Human Immunodeficiency Virus (HIV) is an icosahedral, enveloped virus, of approximately 100 to 110 nm in diameter, and has a single-stranded, linear, positive-sense RNA genome. HIV has two recognized strains, HIV-1 and HIV-2
Growth Conditions	Primarily T-cell based cell lines (ex. SupT1, Jurkat, and CEM)

Health Hazards
Host Range	Humans
Modes of Transmission	HIV is transmitted either by exposure of the virus to oral, rectal, or vaginal mucosa during sexual activity, by intravascular inoculation through transfusion of contaminated blood products, by using contaminated equipment during injection drug use, or from mother to infant during pregnancy, delivery or breastfeeding. Sexual transmission accounts for more than 90% of HIV infections worldwide
Signs and Symptoms	Non-specific symptoms such as lymphadenopathy, anorexia, chronic diarrhea, weight loss, fever, and fatigue; opportunistic infections and malignant diseases without a known cause for immune deficiency. These symptoms often occur months after an initial infection
Infectious Dose	Will vary depending on the transmission route, so there is no baseline dose
Incubation Period	Variable. Commonly the time from infection to the development of detectable antibodies is generally 1 to 3 months; however, the time from HIV infection to diagnosis of AIDS had an observed range of less than 1 year to 15 years or longer

Medical Precautions/Treatment
Prophylaxis	HIV post-exposure prophylaxis regimens are available and based on the nature of the exposure.
Vaccines	None publically available
Treatment	Antiretroviral agents are available, must be managed as a chronic disease
Surveillance	HIV is diagnosed by tests that assess whether an individual's immune system has produced an HIV-specific immune response. Persons who are at risk of exposure should get tested regularly as HIV does not cause obvious symptoms in the early stages
GWU Requirements	Report all incidents to the Office of Risk Management as well as the Office of Research Safety (ORS) IMMEDIATELY FOLLOWING THE OCCURRENCE.

Containment
BSL-2/BSL-2+	Risk Group 2 classification is applied to the species as a whole, but may not apply to every serotype. Containment Level 2 facilities, equipment, and operational practices. No open-Risk Group 3 classification is applied to HIV. Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious material. All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Solid-front gowns with tight-fitting wrists, gloves, and respiratory protection should be worn over laboratory clothing when infectious materials are directly handled. Enhanced containment practices should be taken when working with samples obtained from patients (due to presence of etiologic agents) or with active viral stocks work should be performed with AdV wild type or vectors. All work should be performed inside a Biosafety Cabinet. Centrifuge rotors must have a lid, samples should be loaded/unloaded inside the BSC and the centrifuge should be decontaminated with appropriate disinfectant after use. If the vector is replication incompetent, animals infected with AdV vectors will remain at ABSL-2 for 72h, then moved to ABSL1. If the vector is replication competent, animals will be housed at ABSL2 for the length of the experiment.
BSL-3	For manipulation of concentrated virus, or activities involving large-scale volumes
ABSL-2	For work with NHPs or other animals inoculated with HIV, and their specimens.

Spill Procedures
Small Spills (<1 liter)	If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup. HIV is not known to be transmitted via aerosols, but extra caution should still be taken during a spill outside of a BSC (especially when dealing with patient samples that might contain etiologic agents). Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against enveloped viruses (bleach, glutaraldehyde, hypochlorite, iodine, and phenolics), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.
Large Spills	Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Spill Procedures

Small Spills (<1 liter)

If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup.

HIV is not known to be transmitted via aerosols, but extra caution should still be taken during a spill outside of a BSC (especially when dealing with patient samples that might contain etiologic agents). Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against enveloped viruses (bleach, glutaraldehyde, hypochlorite, iodine, and phenolics), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.

Large Spills

Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Exposure Procedures
Mucus Membrane	Flush eyes, mouth or nose for 15 minutes at eyewash station.
Other Exposure	Wash area with soap and water for 15 minutes.
Reporting	Report ALL injuries to the PI immediately and reported to the Office of Risk Management at [email protected] IMMEDIATELY FOLLOWING THE OCCURRENCE. Exposures that involve a bloodborne-pathogen or recombinant DNA also need to be reported to the Office of Research Safety at [email protected]. If the injury requires immediate medical attention, call GWPD at 202-994-6111 or call 911.
Medical Monitoring	Seek immediate medical evaluation, treatment, and post exposure follow-up at the Employee Health Office at GWU Hospital (900 23rd St., NW, Suite G-1090, Phone: 202-715-4275). Students should go to the Students Health Office at Marvin Center. After hours treatment can be received at the GWU hospital emergency room.

Stability
Disinfection	Susceptible 10% bleach, and 2% glutaraldehyde and to a lesser extent 70% Ethanol, NaOH, and isopropanol
Inactivation	HIV is inactivated by ultraviolet (UV) light, in close proximity; cell-free medium; pH higher or lower than 7.1; temperature higher than 60oC for at least 30 min
Survival Outside Host	Contaminated blood at room temperature for 42 days, and in blood and cerebrospinal fluid from autopsies for up to 11 days

Personal Protective Equipment (PPE)
Minimum PPE Requirements	At minimum, personnel are required to don gloves, closed toed shoes, lab coat, and appropriate face and eye protection prior to working with HIV. Additional PPE may be required depending on lab specific SOPs.
Additional Precautions	Solid-front gowns with tight-fitting wrists, gloves, and respiratory protection should be worn over laboratory clothing when infectious materials are directly handled.

References
CDC (https://www.cdc.gov/hiv/basics/index.html) Innate immune defects in HIV permissive cell lines (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924258/) Canadian PHAC (https://www.canada.ca/en/public-health/services/laboratory-biosafety-bi…)