American Journal of Infectious Diseases

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 Oliveira, Ricardo Sobhie Diaz, Abdallah Harmache, Lisa M. Frenkel, Phalguni Gupta, Gerald H. Learn, James I. Mullins and Michael P. Busch

DOI : 10.3844/ajidsp.2008.244.256

American Journal of Infectious Diseases

Volume 4, Issue 4

Pages 244-256

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.

Copyright

© 2008 Carlos Fernando De Oliveira, Ricardo Sobhie Diaz, Abdallah Harmache, Lisa M. Frenkel, Phalguni Gupta, Gerald H. Learn, James I. Mullins and Michael P. Busch. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.