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Post-exposure prophylaxis and sexual HIV transmission between husband and wife.


Int Conf AIDS. 1998;12:630 (abstract no. 33189). Unique Identifier :

BACKGROUND: Only few data are available concerning the indication, timing, composition and efficacy of post-exposure prophylaxis (PEP) with antiretroviral drugs. METHODS: Highly sensitive assays for integrated proviral DNA in peripheral blood mononuclear cells (PBMC) (lower detection limit: 2 copies/10(6) PBMC) and HIV-1 RNA in plasma (3 copies/ml) were used, and the viral reverse transcriptase gene sequenced in both partners. RESULTS: A 45 year old man presented with symptomatic primary HIV-1 infection (viremia > 10(6) HIV RNA copies/ml) 25 days after a sexual relationship with a female prostitute in Ethiopia. During the 8 days preceding diagnosis he had repeated sexual intercourse with his wife, then the couple used condoms. The man received HAART (IDV, 3TC, ZDV) and 10 days later his wife was started on the same regimen as PEP. At that time, his wife had no antibodies to HIV-1/2 and no detectable viremia (detection limit: 3 copies/ml). She stopped PEP after 1 month but 3 weeks later presented with positive viremia of 14,000 copies/ml. Retrospective analysis by highly sensitive assays of the wife's plasma revealed the intermittent presence of both HIV-1 RNA (approx. 3 copies/ml) and integrated proviral DNA (2-4 copies/10(6) PBMC) during PEP and demonstrated that the circulating virus of both patients presented complete reverse transcriptase sequence homology and harboured no resistance mutations. Both patients had a rapid decrease of viremia after initiation of antiviral therapy and a rapid reconstitution of CD4 and CD8 T cell levels. CONCLUSIONS: In the present case, PEP (IDV, 3TC, ZDV) started 10-18 days after sexual exposure, despite absence of antibodies to HIV-1/2 and undetectable viremia (< 3 copies/ml), failed to prevent HIV infection. Highly sensitive assays for HIV RNA and DNA might help to determine the duration and timing of post-exposure prophylaxis in high-risk patients.

MEETING ABSTRACTS Anti-HIV Agents/*THERAPEUTIC USE AIDS Serodiagnosis Case Report Drug Therapy, Combination Female Human HIV Infections/DIAGNOSIS/*PREVENTION & CONTROL/*TRANSMISSION/ VIROLOGY HIV-1/GENETICS/IMMUNOLOGY Lamivudine/*THERAPEUTIC USE Male Middle Age Prostitution *Spouses Zidovudine/*THERAPEUTIC USE


Information in this article was accurate in December 30, 1998. The state of the art may have changed since the publication date. This material is designed to support, not replace, the relationship that exists between you and your doctor. Always discuss treatment options with a doctor who specializes in treating HIV.