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Previous Volume 329:1835-1841 December 16, 1993 Number 25 Next

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ABSTRACT

Background and Methods We describe a child who apparently acquired human immunodeficiency virus type 1 (HIV-1) infection in the home setting. The suspected source of infection was a child with the acquired immunodeficiency syndrome who had received zidovudine and whose virus contained a mutation associated with in vitro zidovudine resistance. The children were born to different HIV-1-infected mothers, but they lived in the same home between the ages of two and five years. Child 1 was infected perinatally; Child 2 was not and was repeatedly found to be seronegative. Child 2 was examined because of acute lymphadenopathy and had seroconverted to HIV-1 positivity. HIV-1 proviral DNA was amplified from peripheral-blood mononuclear cells and subjected to sequence analysis. Sequences from Child 2 were compared with those from Child 2's mother, Child 1, and local HIV-1-infected control children.

Results HIV-1 nucleotide sequences from the third hypervariable region (V3) of the env gene from Child 2 were much more similar to those of Child 1 (with a difference of 1.3 percent) than to those of Child 2's mother (a difference of 9.9 percent) or those of four local, epidemiologically unrelated children (differences of 10.1 to 16.3 percent). A zidovudine-resistance mutation at codon 215 of the reverse transcriptase gene (Thr-to-Tyr) was found in Children 1 and 2, but not in Child 2's mother. Although the children had no documented exposure to each other's blood, there had been numerous opportunities, including nosebleeds, bleeding gums, and a laceration in Child 1.

Conclusions In the case we describe, HIV-1 with a mutation associated with zidovudine resistance was transmitted from one young child to another, apparently in the home and probably through unrecognized exposure to blood.

Source Information

From the Departments of Molecular Genetics and Microbiology (J.E.F., L.D.F., D.T.D.) and Pediatrics (S.G., L.D.F.), University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, N.J.; the Division of Field Epidemiology, Epidemiology Program Office (F.L.), and the Division of HIV/AIDS, National Center for Infectious Diseases (B.R.E.), Centers for Disease Control and Prevention, Atlanta; and the New Jersey Department of Health, Trenton (F.L.).

Address reprint requests to Dr. Dubin at the Department of Molecular Genetics and Microbiology, UMDNJ-Robert Wood Johnson Medical School, 675 Hoes Ln., Piscataway, NJ 08854.

Full Text of this Article

Related Letters:

Transmission of HIV-1 from One Child to Another
Alimenti A., Levy J., Fremont-Smith K., Dunn D., Newell M.-L., The European Collaborative Study , Friedland G. H., Gaur S., Frenkel L. D., Dubin D. T., Laraque F.
Extract | Full Text  
N Engl J Med 1994; 330:1313-1314, May 5, 1994. Correspondence

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