Abstract
OBJECTIVE: To determine if a case of HIV-infection in a patient
(GP) with common variable immunodeficiency, and with no knownrisk
factors for HIV-infection, could be due to horizontal nosocomial
transmission. METHODS: For determination of time oftransmission
stored serum-samples from GP were analysed for HIV RNA content.
Patient records were used to identify patients, whohad received
intravenous therapy on the same day as GP. Samples from GP and
these possible source patients were identified andphylogenetic
analyses of the env, gag and RT-encoding region of pol were
performed. Furthermore, routines in conjunction withintravenous
therapy were examined. RESULTS: We identified a patient (FDL)
harbouring virus almost indistinguishable from thevirus isolated
from GP. The pairwise nucleotide distance between the C2-V3-C3
region of the env and gag sequences from the twopatients were 1.9
and 0.9% respectively. In addition, GP harboured HIV RNA with a
foscarnet resistance mutation further lendingsupport to virus from
the foscarnet-treated FDL being the source of the infection.
Interestingly, GP experienced increases inimmunoglobulin
production after contracting the HIV-infection, and decreases
after antiretroviral-induced viral suppression. Aclinical
procedure which, under stressful conditions, could lead to
breaches in infection control measures was identified. The source
ofthe infection was most likely a contaminated multidose vial.
CONCLUSION: Through epidemiological and phylogenetic analyses
acase of horizontal nosocomial HIV-transmission was disclosed.
Identification of multidose vials as possible vehicles for
horizontalnosocomial transmission recently led to the
recommendation of restriction of the use of multidose vials, a
recommendation supportedby the present study. The study underlies
the importance of a constant survey of infection control
precautions.
Original language | English |
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Journal | AIDS |
Volume | 13 |
Issue number | 13 |
Pages (from-to) | 1737-44 |
Publication status | Published - 1999 |