TY  - JOUR
AU  - De Oliveira, Carlos Fernando 
AU  - Diaz, Ricardo Sobhie 
AU  - Harmache, Abdallah 
AU  - Frenkel, Lisa M. 
AU  - Gupta, Phalguni 
AU  - Learn, Gerald H. 
AU  - Mullins, James I. 
AU  - Busch, Michael P. 
PY  - 2008
TI  - Passive Transfer of HIV-1 Antibodies and Drug Resistant Virus during a Health Care Worker Accident: Implications for HCW Post-Exposure Management
JF  - American Journal of Infectious Diseases
VL  - 4
IS  - 4
DO  - 10.3844/ajidsp.2008.244.256
UR  - https://thescipub.com/abstract/ajidsp.2008.244.256
AB  - 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.