Transmission From One Child To Another Of Human Immunodeficiency Virus Type 1 With A Zidovudine-Resistance Mutation

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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 given 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. (N Engl J Med 1993;329:1835-41.)

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