Gaur Aditya H, Dominguez Kenneth L, Kalish Marcia L, Rivera-Hernandez Delia, Donohoe Marion, Brooks John T, Mitchell Charles D
Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA.
Pediatrics. 2009 Aug;124(2):658-66. doi: 10.1542/peds.2008-3614. Epub 2009 Jul 20.
Although some caregivers are known to premasticate food for infants, usually during the weaning period, HIV transmission has not been linked to this practice. We describe 3 cases of HIV transmission in the United States possibly related to this practice.
Three cases of HIV infection were diagnosed in children at ages 9, 15, and 39 months; clinical symptomatology prompted the testing. A thorough investigation to rule out alternative modes of transmission was conducted. In addition, phylogenetic comparisons of virus from cases and suspected sources were performed by using the C2V3C3 or gp41 region of env and the p17 coding region of gag.
In 2 cases, the mothers were known to be infected with HIV, had not breastfed their children, and perinatal transmission of HIV had previously been ruled out following US HIV testing guidelines. In the third case, a great aunt who helped care for the child was infected with HIV, but the child's mother was not. All 3 children were fed food on multiple occasions that had been premasticated by a care provider infected with HIV; in 2 cases concurrent oral bleeding in the premasticating adult was described. Phylogenetic analyses supported the epidemiologic conclusion that the children were infected through exposure to premasticated food from a caregiver infected with HIV in 2 of the 3 cases.
The reported cases provide compelling evidence linking premastication to HIV infection, a route of transmission not previously reported that has important global implications including being a possible explanation for some of the reported cases of "late" HIV transmission in infants, so far attributed to breastfeeding. Until the risk of premastication and modifying factors (eg, periodontal disease) are better understood, we recommend that health care providers routinely query children's caregivers and expecting parents who are infected with HIV or at risk of HIV infection about this feeding practice and direct them to safer, locally available, feeding options.
虽然已知有些照料者会在婴儿断奶期为其咀嚼食物，但尚未发现这种行为与艾滋病毒传播有关。我们描述了美国3例可能与此行为相关的艾滋病毒传播病例。
3例儿童分别在9个月、15个月和39个月时被诊断出感染艾滋病毒；临床症状促使进行检测。对排除其他传播途径进行了全面调查。此外，利用env的C2V3C3或gp41区域以及gag的p17编码区域，对病例和疑似传染源的病毒进行了系统发育比较。
在2例病例中，已知母亲感染艾滋病毒，未对孩子进行母乳喂养，且根据美国艾滋病毒检测指南，此前已排除艾滋病毒的围产期传播。在第三例中，帮助照料孩子的姑奶奶感染了艾滋病毒，但孩子的母亲未感染。所有3名儿童都多次食用了由感染艾滋病毒的照料者咀嚼过的食物；在2例中，描述了咀嚼食物的成年人同时存在口腔出血的情况。系统发育分析支持了流行病学结论，即在3例病例中的2例中，儿童是通过接触感染艾滋病毒的照料者咀嚼过的食物而感染的。
报告的病例提供了令人信服的证据，将咀嚼食物与艾滋病毒感染联系起来，这是一种此前未报告过的传播途径，具有重要的全球意义，包括可能是一些婴儿“晚期”艾滋病毒传播病例的原因，迄今为止这些病例被归因于母乳喂养。在更好地了解咀嚼食物的风险和影响因素（如牙周病）之前，我们建议医疗保健提供者常规询问感染艾滋病毒或有感染艾滋病毒风险的儿童照料者和准父母这种喂养方式，并指导他们选择更安全、当地可获得的喂养方式。
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