Janini LM, Tanuri A, Schechter M, Ramos A, Schochetman G, Rayfield M, Pieniazek D; Centers for Disease Control and Prevention, Atlanta, GA.
Dual HIV-1 infections caused by viruses of distinct subtypes have been molecularly documented in Brazil and Thailand. However, it is unknown if the acquisition of the viruses in dually infected patients is sequential or simultaneous. This information is important as HIV-1 multiple infections may have implications for immunotherapies and influence on the evolution of the HIV/AIDS pandemic. Here, we present an unique case of transmission of HIV-1 dual infection within a Brazilian family consisting of parents and their child. The child had a history of opportunistic infections since one month after being born, and her positive HIV-1 serology led to initial testing of parents. They were shown to be seropositive but suffered only from persistent generalized lymphodenopathy. Potential dual HIV-1 infection was detected in each patient's peripheral blood mononuclear cells (PBMC) by a genetic assay based on endonuclease restriction site polymorphism in the pro-viral protease gene, which allowed for distinguishing between multiple infections involving HIV-1 strains of distinct subtypes and those caused by viruses of singular subtype. Sequence and phylogenetic analysis of cloned pol (protease), gag (p24 region) and env (C2-v3 domain) genes confirmed dual infection in each member of the family caused by HIV-1 strains of subtypes B and C. The viruses exhibited 99% sequence homology between the variants of each subtype from the parents and their child. These data together with epidemiological information indicate that viruses entering the family because of the father's high-risk activities, have been passed to the mother, and vertically transmitted to the child. Our finding provide the first evidence that dual infections caused by viruses of distinct HIV-1 subtypes can be both sexually and maternally transmitted.
Keywords: AEGIS, Disease Transmission, Vertical, HIV Infections, HIV-1, Acquired Immunodeficiency Syndrome, Variation (Genetics), Brazil, Thailand, Child, Human, virology, transmission, genetics, AIDS
