The first report, scheduled for publication in this week’s New England Journal of Medicine, involves two young children living in the same foster home in New Jersey. (Researchers aren’t divulging the kids’ sexes or exact ages but refer to them as girls for convenience.) Though both were born to HIV-infected mothers, only one (the older of the two) was infected at birth. Eighteen months ago, when the younger one developed swollen glands and a fever, doctors at the University of Medicine and Dentistry of New Jersey discovered that she was infected. The virus in her blood matched that of her foster sister. No one knows precisely how the transmission occurred, but an investigation pinpointed situations in which blood could have passed between the two. The older child suffered frequent nosebleeds, while the younger one had lesions on her arms from dermatitis. And the two sometimes shared a toothbrush despite the older child’s bleeding gums.
The second case, described in a forthcoming bulletin from the Centers for Disease Control and Prevention (CDC), involves a pair of teenage brothers with hemophilia. The older brother contracted HIV from contaminated blood products and has tested positive since 1985. The younger one tested negative until recently, when tests showed that he was infected with a viral strain that matched his brother’s. As hemophiliacs, both boys used injection equipment to administer the clotting factor they needed, but the CDC researchers found no evidence that they’d shared their needles or had sex together. What they did share was a razor blade, which may have cut them both in quick succession.
The fear of such accidents has spawned plenty of passion in recent years. In 1987 a Florida couple’s house was firebombed after a court declared that their three infected boys could attend public school. Though the CDC has always opposed broad restrictions on infected kids, the agency adopted guidelines in 1985 for preventing mishaps. The standard precautions include covering open sores, wearing gloves and washing hands when changing a diaper or dressing a wound, disinfecting the soiled surfaces and not sharing razors or toothbrushes. Lapses may be inevitable, but serious ones have been exceedingly rare. In more than a dozen studies, researchers have tracked AIDS patients’ family members and found no evidence of the virus spreading through household contact. Two children now stand as exceptions to that rule. The good news is that it’s taken researchers 12 years and 340,000 AIDS cases to find them.
