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New York Times
Pre-Chewed Baby Food Said to Transmit H.I.V.
Lawrence K. Altman
February 7, 2008
BOSTON - Researchers have identified another way that babies can be infected with H.I.V. - through food pre-chewed by an infected parent or caretaker.

Although thousands of babies have been infected in the United States over the last 15 years, pre-chewed food has been documented as the cause of just three cases, federal epidemiologists said here Wednesday.

But such transmission may not be so rare, Dr. Kenneth L. Dominguez's team from the Centers for Disease Control and Prevention said at the 15th Conference on Retroviruses and Opportunistic Infections.

Pre-chewing food apparently occurs among many groups in this country and elsewhere. So transmission of H.I.V., the AIDS virus, to infants may be an unrecognized problem in developing countries where dental care is lacking, commercially prepared baby foods and blenders are not available and parents and caretakers may need to soften foods, Dr. Dominguez said in an interview.

His team said there were several reasons for reporting the three cases, dating from 1993, for the first time. One was to make health care providers and caregivers of infected children aware of the potential risk of pre-chewing. Another was to ask doctors and family members to report suspected cases to health officials to quantify the threat.

Human immunodeficiency virus is present in saliva, but usually in amounts too low to cause transmission. So, presumably, blood, which has larger amounts of the virus, is also needed for transmission.

Infected chewers with inflammations or open mouth sores can pass the virus to infants through cuts or other common teething conditions, Dr. Dominguez said.

Although the three cases were among African-Americans born in the United States, pre-chewing is prevalent among many ethnic and racial groups, according to a recent national survey of infant feeding by the C.D.C., Dr. Dominguez said.

Specific findings from the survey have not been released.

"It's likely that some cultural influences are involved, and I am sure that people are doing what their grandmothers and aunties did in practices carried through generations," Dr. Dominguez said.

Epidemiologists from the centers, working with researchers at St. Jude Children's Research Hospital in Memphis and the University of Miami, intensively investigated all three cases, ruling out other causes of transmission like breast feeding, sexual abuse and needle sticks.

The first two cases involved boys from Miami infected in the mid-'90s. One boy's infection was detected when he was 39 months old, shortly before his death, after previously testing negative for the virus twice. The mother, who was infected, reported pre-chewing food for the boy.

The second boy's mother was uninfected but lived with an infected aunt who pre-chewed his food. He survives. In the third case, a girl from Memphis was found to be infected in 2004 at 9 months old after testing negative for the virus three times. Her mother was infected and pre-chewed food for her daughter.

Genetic studies showed that the viruses isolated from the first and third cases matched those of the mother. The second case's caregiver died before blood samples could be obtained. H.I.V. isolated from the caregiver's infected male sexual partner did not match that from the boy.

Researchers will try to determine whether other dangerous microbes like hepatitis B virus and Helicobacter pylori might be transmitted through pre-chewed food.



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