Research Article Open Access

Passive Transfer of HIV-1 Antibodies and Drug Resistant Virus during a Health Care Worker Accident: Implications for HCW Post-Exposure Management

Carlos Fernando De Oliveira1, Ricardo Sobhie Diaz2, Abdallah Harmache3, Lisa M. Frenkel4, Phalguni Gupta5, Gerald H. Learn3, James I. Mullins3 and Michael P. Busch6
  • 1 Blood Systems Research Institute, Brazil
  • 2 Federal University of Sao Paulo, Brazil
  • 3 University of Washington, United States
  • 4 Children’s Hospital and Medical Center, United States
  • 5 University of Pittsburgh, United States
  • 6 University of California, United States

Abstract

Problem statement: We studied in detail a case in which a nurse caring for an HIV-infected child suffered a deep-laceration accident with contaminated blood. Approach: The patient had been treated with zidovudine (ZDV) and the nurse became infected despite prophylactic use of ZDV initiated 2 h after the accident. A reactive anti-HIV-1/2 EIA and an indeterminate western blot (gp120/160 reactivity) were obtained from the nurse on the day of the accident, suggesting preexposure infection. However, a negative western blot and positive DNA PCR were documented 10 days after the accident and seroconversion occurred an additional two weeks later. Results: Phylogenetic analyses of HIV-1 tat and C2-C4-gp120 env regions confirmed that the nurse infected by two different HIV-1 strains present in the child. Strains present in both subjects revealed multinucleoside resistant HIV-1. Dilutional serological studies using 10 HIV-infected patients’ sera demonstrated that passive seroreactivity could occur with infusion of less than 1 uL of blood when highly sensitive assays are employed. Conclusion: This is the first well-documented case of passive HIV antibody detection after a percutaneous exposure. Reactive baseline serology should not be assumed to represent prior infection nor exclude prophylaxis. Transmission of drug-resistant HIV-1 corroborates the medical history and supports use of drug history and resistance testing to guide antiretroviral prophylaxis.

American Journal of Infectious Diseases
Volume 4 No. 4, 2008, 244-256

DOI: https://doi.org/10.3844/ajidsp.2008.244.256

Submitted On: 2 February 2009 Published On: 31 December 2008

How to Cite: De Oliveira, C. F., Diaz, R. S., Harmache, A., Frenkel, L. M., Gupta, P., Learn, G. H., Mullins, J. I. & Busch, M. P. (2008). Passive Transfer of HIV-1 Antibodies and Drug Resistant Virus during a Health Care Worker Accident: Implications for HCW Post-Exposure Management. American Journal of Infectious Diseases, 4(4), 244-256. https://doi.org/10.3844/ajidsp.2008.244.256

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Keywords

  • HIV-1
  • passive transfer of antibodies
  • health care work accident
  • bottleneck
  • transmission of resistant HIV-1