CROI: Three children in US infected with HIV from pre-chewed food

Three cases of HIV infection in small children in the United States are being linked to the practice of pre-chewing solid food before giving it to small children. In each case the children appear to have been exposed to blood from the mouth of an adult caregiver, investigators from the US Centers for Disease Control reported on Wednesday at the Fifteenth Conference on Retroviruses and Opportunistic Infections in Boston.

After ruling out other routes of transmission, such as breastfeeding, sexual abuse, blood transfusion or needlestick injury, the investigators looked at caregivers and discovered that in two cases, HIV-positive mothers were in the habit of giving pre-chewed food to their infants. In one case the child died of AIDS before the route of transmission was discovered, but the other child is receiving antiretroviral treatment.

In the third case, a child was diagnosed with HIV at the age of 15 months, in 1993. The infant’s mother was HIV-negative, and the strain of HIV carried by her HIV-positive partner was genetically dissimilar to the infant’s strain, prompting the investigators to look elsewhere. They subsequently discovered that the child’s great-aunt had often looked after the child between the ages of nine and 14 months, and had given it pre-masticated food. She died of AIDS in 1993.

They also discovered that in two of the three cases, medical records showed evidence of bleeding gums and mouth sores during the period they were giving pre-masticated food to the infants. In the third case no information was available on the caregiver’s oral health for the period prior to the child’s infection, but the virus found in the child was closely related, and no other explanation could be found for the child’s HIV infection.

At present the US CDC cannot say how common the practice of pre-masticating food might be in the United States, nor how much of a risk it poses for HIV transmission, but they advise that HIV-infected parents and other caregivers should avoid pre-masticating food, especially if they have bleeding gums, sores in the mouth or other open wounds in or around the mouth.

In developing countries US CDC believes pre-mastication may be more common due to the lack of prepared baby foods, so it may pose a greater risk in settings where HIV prevalence is high and oral health poor.