P. Van de Perre

Isolation of aids virus from cell-free breast milk of three healthy virus carriers

The authors investigated postnatal transmission of acquired immunodeficiency syndrome (AIDS) to 3 breastfed infants whose mothers had been virus free at birth but became infected shortly afterward as a result of blood transfusions. In the 1st family the 5-month old infant was admitted to the hospital with splenomegaly fever failure to thrive and nonoathogenic diarrhea. She had not been given any blood products and was breastfed. The father was from Belgium and the mother from Zaire. In the 2nd family the father who had lived in Zaire for 10 years had generalized lymphadenopathy presumably a result of a blood transfusion. In the 3rd family the infant had a maculopapular rash at 2 months and began to show failure to thrive and fever. At 5 months she developed interstitial pneumonia. Both parents were from Rwanda. Breast milk samples provoked the appearance to human T-lymphotropic virus type III (HTLV-III) antigens. 2 mothers had antibodies to HTLV-III in their serum and antibodies in milk should now be investigated.

ARE MEDICAL INJECTIONS A RISK FACTOR FOR HIV INFECTION IN CHILDREN

In 1984-86 the authors diagnosed 107 cases of acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) in 107 children at Rwandas Centre Hospitalier de Kigali. Of the 76 children who were available for medical examination serologic study and interview only 18 (24%) had seronegative mothers. This finding suggests that the role of blood transfusion and medical injection in the transmission of human immunodeficiency virus (HIV) to children may not be as significant as is generally believed. A history of blood transfusion was found in 7 of the 18 children with HIV seronegative mothers but in only 3 of the 58 children whose mothers were seropositive. However there was no difference between the 2 groups in terms of the number of medical injections per month of life. The absence of a history of transfusion in 11 of the 18 children with seronegative mothers prompted a re-evaluation of the serological status of these women by indirect immunofluorescence and HIV env/core recombinant confirmation enzyme immunoassay. 2 of the 8 mothers of children without a transfusion history and 1 of 4 mothers of children with previous transfusion were found to have strong positive results with both core and env antigen by enzyme immunoassay. Thus it is recommended that seronegativity in mothers should be confirmed before parenteral exposure to HIV is implicated in HIV seropositive children.

ANTIBODY TO HTLV-III IN BLOOD DONORS IN CENTRAL AFRICA

This letter reports an African case of acquired immunodeficiency syndrome (AIDS) transmitted through blood transfusion. The patient a 17-year old healthy woman from Rwanda received 6 units of whole blood as a result of severe postpartum bleeding. 6 months later the patient developed generalized lymphadenopathy fever weight loss fatigue and diarrhea. The following month her infant died from dehydration related to gastroenteritis. 9 months after the transfusion Mycobacterium tuberculosis adenitis was diagnosed and massive esophageal candidiasis was discovered. Delayed hypersensitivity skin testing was positive for purified protein derivative but negative for candida and phytohemagglutinin. She was hepatitis B surface antigen positive and had antibodies to the core antigen. Enzyme-linked immunosorbent assay indicated antibodies to human T-lymphotropic virus type III (HTLV-III). The OKT4/OKT8 ratio was 0.01 with an absolute OKT4+ count of 26/mcgl. The patient did not belong to a recognized AIDS risk group and reported only 1 sexual partner. Follow-up of the 6 blood donors found that all were African male homosexuals 1 of whom was seropositive for HTLV-III infection. The short latency period between blood transfusion and onset of symptoms is hypothesized to have been facilitated by the physiologic immunosuppression associated with pregnancy. The prevalence of HTLV-III seropositivity in Rwandese blood donors was 18% in 1 study.

Broadly neutralizing, MN-like PND-directed antibodies in Rwandan children with long-term HIV1 infection.

Sera from 11 perinatally HIV1-infected Rwandan children with prolonged survival were tested in vitro for the presence of neutralizing antibodies against different HIV1 strains. These 11 sera from long survivor (LS) children were compared with 16 sera from Rwandan children with AIDS. Sera from HIV1-infected children exhibited the greatest neutralizing activity against HIV1MN cell-free infection. They also inhibited HIV1RII and HIV1LAI cell-free infection with lower titres. Higher neutralization titres were observed in sera from LS compared to the AIDS group, with a significant difference for HIV1MN and HIV1LAI strains. Sera from LS children also inhibited syncytium formation induced by HIV1MN-infected cells with higher titres than AIDS children. Sera from the HIV1-infected children showed reactivity to the HIV1MN V3 peptide, as well as to both the US/European and the African consensus V3 peptides. Higher reactivity was observed in sera from LS than from AIDS children, and the difference was significant toward the African consensus peptide. The LS children also had significantly higher V3MN IgG avidity than the AIDS children. These data support the notion that the humoral response to the V3 domain, associated with a broadly neutralizing activity, may be an important factor in the prolonged survival of these children. The specificity against HIV1MN also suggests that an antigenically MN-related strain may be prevalent in Rwanda, and that an MN-related principal neutralizing domain sequence could be an important determinant for candidate vaccines in this part of Africa.