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Athletes with HIV, HBV and HCV should be permitted to participate in sports

AAP releases new policy statement that says exposure to blood poses small risk.

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January 2000

CHICAGO - The American Academy of Pediatrics in a recent policy statement said that athletes with HIV, hepatitis B or C viruses (HBV, HCV) should be allowed to participate in all sports because exposure to blood poses a very small risk of infection.

Athletes and the staff of athletic programs should take steps to protect themselves from HIV, HBV or HCV. The AAP also said that HBV is more easily transmitted by exposure to infected blood than is HIV. Therefore, anyone at risk of exposure to athletes' blood, such as athletes, coaches, trainers and equipment personnel, should receive the hepatitis B (HepB) vaccine.

Other precautions should be taken, including specific cleaning procedures for equipment and playing areas contaminated by blood, using an appropriate cleanser such as a bleach solution containing one part bleach in 10 parts water.

Any athlete with active bleeding should be removed from competition until the bleeding has stopped and the wound has been cleaned and covered. In addition, athletes should not share personal items, such as razors, toothbrushes and nail clippers that might be contaminated with blood. Athletes should also receive education about the greater risks of transmission of bloodborne illnesses through sexual activity and needle sharing.

The AAP has addressed HIV and athletics before, but this is the first policy to address HBV or HCV and athletes.

The athlete's infection status is confidential, the AAP said, and informed consent must be given before pediatricians may share this information with a school or sports organization. Routine testing of athletes for these viral infections is not indicated.

Infected athletes should be counseled about their infection and told of the small risk they hold of infecting others. Although the extent of this risk is unknown for any sport, it is probably greatest for wrestling and boxing, the AAP said. The AAP discourages any youth from participating in boxing and recommends that pediatricians advise athletes not to participate in this sport, whatever their infection status.

Strict safety precautions are important for those in athletic programs who provide first aid and have repeated exposure to blood or other bodily fluids visibly contaminated with blood.

Recommendations for Athletes with HIV, HBV and HCV

Athletes with HIV, HBV, or HCV should be allowed to participate in all competitive sports. Pediatricians should respect the athlete's right to confidentiality. Athletes should not be tested routinely for bloodborne pathogens because they are sports participants. Counsel positive athletes that they have a very small risk of infecting other competitors. Aggressively promote Hep B immunization among athletes and staff.

Coaches and staff should learn first aid and emergency care and in preventing transmission of bloodborne pathogens in the athletic setting. Teach athletes about the risks of bloodborne pathogen transmission through sexual activity and needle sharing. Personal items that might be contaminated with blood should not be shared. Compliance with OSHA regulations is a reasonable and recommended precaution even if not specifically required by the state.

For more information:

• AAP Committee on Sports Medicine. Human immunodeficiency virus and other bloodborne viral pathogens in the athletic setting. Pediatrics. 1999;104:1400-03.
• American Academy of Pediatrics. In: Pickering LK, ed. 2000 Red Book. Report of the Committee on Infectious Diseases 25th ed, Elk Grove Village, IL: American Academy of Pediatrics. In press.

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Copyright 2000, SLACK Incorporated. Revised 15 September 2000.