In order to deal correctly with opportunistic infectious disease that can easily occur in HIV or AIDS patients, it is extremely important to differentiate between developing and developed countries. This is because they represent a completely different setting for different scenarios in relation to human habits, epidemiological patterns and interplay between human beings and animals.
In developed countries, the most frequent patterns through which HIV or AIDS patients contract a zoonosis is by means of direct contact with pets or consumption of contaminated food of animal origin. In developing countries, the most frequent patterns are characterized by direct contact with farm or wild animals and their products. It means that different risks and mechanisms of spreading of zoonotic agents exist according to the considered geographical areas. Those differences have to be taken into account when organizing an effective control strategy.
It is very evident that interactions between animals and humans are truly complex and health care providers should be aware of the potential role of animals in transmitting infectious diseases to HIV or AIDS infected patients. HIV or AIDS patients are not obliged to get rid of their pets, or to avoid any contact with animals or eliminate the consumption of food of animal origin, but they should be informed about the risks connected with their actions and if there is a way to reduce the potential hazard connected with animals.
Overall, we can define two different critical points that have to be considered in reducing the risk of infection due to opportunistic pathogens for HIV or AIDS patients: food of animal origin and direct contact with animals, either pets or farm animals.
Food safety is a complicated issue that involves many professionals, but the basic rules for minimizing the risk of consuming infected food, are based on the concept that most zoonotic food-borne opportunistic pathogens are temperature-sensitive and are contaminating, not infecting agents. This implies that foodstuffs are contaminated along the production chain between slaughter and the consumers table. We will focus on particular aspects that have to be followed by immunocompromised consumers. The general rules listed below are not related to single pathogens. Most are applicable either in developed or developing countries. A more detailed description for every pathogen is reported separately.
Avoid eating raw or undercooked meat, poultry, fish and eggs. This reduces the risk of ingesting pathogens that commonly infect or contaminate these foodstuffs.
Avoid food cooked without evidence of high hygienic standards. Restaurants, take-away or deli-prepared food should be avoided if at all possible. Where eating in this way is unavoidable, order simple foods that need little preparation, such as well-done grilled meat.
Food must be handled properly and safely from purchase to consumption. As a general rule, the risk of contamination is directly proportional to the amount of handling. This means that the more food is handled, prepared or seasoned, the more it is at risk from contamination.
Consider raw meat as a potential contaminating agent. Store it separately. Avoid storing meat for longer than three days in a refrigerator.
Wash hands and utensils carefully before starting to cook. Use glass or dedicated wooden cutting boards when preparing meat. This avoids the cross-contamination of bacteria present in meat to other foods that will not be cooked before consumption.
Refrigerate leftovers immediately after a meal, divide into shallow containers and cover them with plastic wrap or aluminium foil. Do not store leftovers for more than three or four days and re-heat them thoroughly before consumption.
Milk could be a frequent source of pathogens for humans and should be pasteurized or boiled just before consumption. Milk products should use pasteurized milk and should be maintained at an appropriate humidity and temperature;
Other sources of infection could be water, vegetables and fruits. To minimize the risks from these types of food, drink only canned or bottled water or drinks. Use ice made from boiled water. Avoid uncooked vegetables and salads or unpeeled fruit.
Direct contact with pets or farm animals is a frequent source of infection for immunocompromised humans. To minimize the risks from these sources such people are strongly advised to:
avoid direct contact with animal faeces;
wash hands after touching objects that may be contaminated with faeces of animal origin;
remove faeces daily from any litter trays and wash hands thereafter.