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"CASUAL" TRANSMISSION OF HIV: TWO CASE REPORTS.

Two reports demonstrate that on rare occasions, HIV can be transmitted by means other than sexual contact, needles, blood products, or perinatal exposure.

The first report describes apparent transmission between two children who lived together and were born to HIV- infected mothers. Child 1 was diagnosed with AIDS at 18 months of age. Child 2 was HIV-negative at 18 months, but at age 2.5 developed sleep disturbance, easy fatigability, and tender cervical and axillary adenopathy. Genetic analysis showed that Child 2 had a newly acquired HIV strain that was different from his mother's but virtually identical to Child 1's in its nucleic acid sequence. Moreover, like Child 1's strain, Child 2's strain was resistant to AZT; Child 1 had been treated with AZT, but Child 2's mother had not. Researchers believe that Child 2's mucous membranes or excoriated skin lesions may have been exposed to blood from Child 1, who had frequent nosebleeds and bleeding gums.

The second report documents apparent HIV transmission between two adolescent hemophiliac brothers. One brother contracted HIV infection from unscreened factor VIII concentrate. More than 3 years later, his younger brother seroconverted and was found to have a genetically similar HIV strain. The time interval between the two infections strongly suggested that HIV was spread from brother to brother, rather than originating from a common source. The most likely transmission mechanism was blood contact from a shared razor. Comment: Although casual transmission of HIV can occur, it is very rare. The predominant message from these reports is that special precautions should be taken to prevent any contact with HIV-infected blood.

— AL Komaroff and DM Berwick

Published in Journal Watch General Medicine January 4, 1994

Citation(s):

HIV transmission between two adolescent brothers with hemophilia. MMWR Morb Mortal Wkly Rep 1993 Dec 17 42 948-951.

• Medline abstract (Free)

Fitzgibbon JE et al. Transmission from one child to another of human immunodeficiency virus type 1 with a zidovudine-resistance mutation. N Engl J Med 1993 Dec 16 329 1835-1841.

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• Medline abstract (Free)