title: Invisible bleeding from clean-shave haircuts: detection with blood specific RNA markers.
abstract: BACKGROUND
  'Haircut-associated bleeding' is a newly recognized entity that affects at least a quarter of African men who wear shiny clean-shave ('chiskop') haircuts.
  
  
  OBJECTIVE
  This pilot study aimed to elucidate whether invisible haircut-associated bleeding was detectable using blood specific RNA markers (16 participants, 5 with unknown HIV status) and whether surface virus could be detected using PCR from scalp swabs (of 11 known HIV-positive participants).
  
  
  METHODS
  Haircuts were performed professionally and scalps examined by a dermatologist to exclude injury. Serum samples for viral loads were also collected at the same time.
  
  
  RESULTS
  In all, 6/16 (37%) samples tested positive (>100 relative fluorescent units) for hemoglobin beta and albumin, confirming evidence of blood; of these, only 1/11 was HIV-positive but had an undetectable serum viral load. No surface HIV was detected from any scalp samples.
  
  
  CONCLUSIONS
  This study confirms the entity of haircut-associated bleeding but goes further to show for the first time that invisible bleeding from clean-shave haircuts is also common. Both a high serum viral load and evidence of bleeding should ideally be present prior to surface HIV detection. Future investigations for potential HIV (and hepatitis B) transmission through clean-shave haircuts are warranted but should not delay public education for disease prevention.
authors.affiliation: Division of Dermatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: N P
authors.initials: NP
authors.lastname: Khumalo
authors.forename: K
authors.initials: K
authors.lastname: Mkentane
authors.forename: C
authors.initials: C
authors.lastname: Muthukarapan
authors.forename: D
authors.initials: D
authors.lastname: Hardie
authors.forename: S
authors.initials: S
authors.lastname: Korsman
authors.forename: N
authors.initials: N
authors.lastname: Hu
authors.forename: T
authors.initials: T
authors.lastname: Mthebe
authors.forename: L M
authors.initials: LM
authors.lastname: Davids
authors.forename: J
authors.initials: J
authors.lastname: Rousseau
mesh_terms: D000418:Albumins / Q000235:genetics; D001461:Barbering; D015415:Biomarkers / Q000032:analysis; D017848:Blood-Borne Pathogens / Q000302:isolation & purification*; D006678:HIV / Q000235:genetics / Q000302:isolation & purification*; D006679:HIV Seropositivity / Q000097:blood*; D006470:Hemorrhage / Q000097:blood* / Q000209:etiology; D006801:Humans; D008297:Male; D010865:Pilot Projects; D012333:RNA, Messenger / Q000032:analysis*; D012535:Scalp / Q000293:injuries / Q000821:virology; D012867:Skin / Q000293:injuries / Q000821:virology; D012871:Skin Diseases / Q000097:blood* / Q000209:etiology; D019562:Viral Load; D055544:beta-Globins / Q000235:genetics
chemical_list: D000418:Albumins; D015415:Biomarkers; D012333:RNA, Messenger; D055544:beta-Globins