Immunodeficiency virus transmission

The aim of the present study was to document the FIV serological status of cats taken into two rescue shelters. A study was performed that combined a retrospective review of records of FIV serological status at intake Test 1 and prospective FIV serological testing Tests 2 and 3.

Retrospective records were analyzed at rescue shelter 2 Rescue 2 , where FIV-positive queens with litters of nursing kittens were taken into the shelter, before being rehomed.

FIV serology was performed on all kittens after weaning. Type Accommodation and the title of the report in the subject line of e-mail. CDC received a case report of acquired immunodeficiency syndrome AIDS in a young woman for whom an epidemiologic investigation had not established a source for her human immunodeficiency virus HIV infection i. Information on the dental procedure was obtained from interviews with the patient and reviews of her dental records and radiographs. This report summarizes the epidemiologic and laboratory findings of the investigation.

The patient had two maxillary third molars extracted under local anesthesia in the dentist's office. The dentist had been diagnosed with AIDS 3 months before performing the procedure. Written documentation of the procedure was limited. Review of the radiographs indicated that the maxillary third molars were not impacted in bone.

The patient reported that she received no general anesthetic or sedative and that during the procedure the dentist wore gloves and a mask. She did not recall, nor did review of the dental records reveal, any circumstances that would have exposed her to the dentist's blood i.

The patient had not received dental care from this dentist before the dental extractions. Four weeks after the dental procedure, the patient sought medical evaluation for a sore throat. Review of her medical records revealed that she was afebrile, with moderately enlarged tonsils with ulcerations and moderately enlarged nontender anterior cervical lymph nodes. Rash, generalized lymphadenopathy, or fatigue were not reported or noted on the medical record.

A "strep antigen" test was negative. The patient was diagnosed with pharyngitis and aphthous ulcers. Seventeen months after the procedure, she was diagnosed with oral candidiasis; 24 months after the procedure, she was diagnosed with Pneumocystis carinii pneumonia and was seropositive for HIV antibody. The patient reported no previous test for HIV infection. Multiple interviews of the patient and her family and friends by health department staff and review of her medical and previous dental records did not identify factors that may have potentially placed her at risk for HIV infection.

The patient reported no history of blood transfusions, IV-drug use, acupuncture, tattoos, or artificial insemination. Additionally, she denied a history of sexually transmitted diseases or pregnancies.

VDRL and hepatitis B serologies were negative. The patient has never been employed in a health-care or other setting where she could have been exposed to HIV-infected blood or other body fluids.

Blood specimens were obtained from the patient and the dentist. HIV sequences encoding the variable regions V3, V4, and V5 and a constant region C3 of the major external glycoprotein gp were selectively amplified using the polymerase chain reaction PCR 1.

The relatedness of the sequences was analyzed by several computer-based methods in collaboration with Los Alamos National Laboratory. Although the viral sequences from the dentist and the patient could be distinguished from each other, they were closer than what has been observed for pair-wise comparisons of sequences taken from the other North American isolates studied 3.

Editorial Note: The case reported here is consistent with transmission of HIV to a patient during an invasive dental procedure, although the possibility of another source of infection cannot be entirely excluded.

No case of such transmission has been previously described. In this report, the possibility that the patient may have been infected with HIV during the dental procedure is based on the following considerations: 1 the patient had an invasive procedure performed by a dentist with AIDS such procedures have been associated with transmission of hepatitis B virus, which is also a bloodborne pathogen, to patients ; 2 an epidemiologic investigation did not identify any other risk factors or behaviors that may have placed the woman at risk for HIV infection; and 3 viral DNA sequences from the patient and the dentist were closely related.

These three considerations are discussed as follows. First, although the dentist was infected with HIV, it is uncertain whether the patient was exposed to the dentist's blood during the extraction procedure. When interviewed more than 2 years after the procedure, the patient recalled that the dentist wore gloves and a mask.

The dental records contained few details on the extraction procedure, but there was no mention of any circumstances that may have exposed the patient to the dentist's blood. Review of the dental records and radiographs suggest that the extraction should have been uncomplicated. The dentist recalled occasional needlesticks with narrow-gauge needles used to administer local anesthetic. After the diagnosis of HIV infection, however, the dentist did not recall sustaining a needlestick or cut resulting in visible blood during a procedure.

The dentist, who is negative for hepatitis B surface antigen, is no longer in practice. Although the dentist employed assistants, it could not be determined whether or to what extent the dentist was assisted in the procedure reported here; it is not known whether the assistants were tested for HIV infection. Details of the disinfection and sterilization practices of the dental office are unknown.

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