Transmission of drug-resistant HIV-1 from an infected individual to a caregiver.

OBJECTIVE: To describe a suspected case of intrafamilial transmission of drug-resistant HIV-1 from an infected individual to his caregiver. METHODS: HIV-1 protease, reverse transcriptase, nef and gp41 DNA sequences were determined from plasma samples after RNA extraction and nested RT-PCR. Phylogenetic trees were generated using neighbour-joining methods. RESULTS: HIV-1 infection was diagnosed in an individual (index) following the death of her HIV-infected adopted son (source). The index case cared for her son in the 9 months prior to his death. No obvious instances of contact with bodily secretions or other traditional risk factors for HIV transmission were identified, although the index case had mild eczema. At time of death, the source case's HIV plasma viral load was > 1,000,000 HIV copies/ml. Genotyping of the protease and reverse transcriptase of both the source and index samples revealed similar drug-resistance mutations despite the index case being antiretroviral-naive. Both source and index V3 genotypes were consistent with syncytium-inducing virus. The mean pairwise amino acid identity between the source and index samples was 97.0%, 99.2%, 92.6% and 94.6% in protease, reverse transcriptase, nef and gp41, respectively. The source and index sequences clustered together on phylogenetic trees when compared with 50 randomly selected sequences from British Columbia. CONCLUSION: Although exceptionally rare, our case demonstrates transmission of drug-resistant HIV-1 from an infected individual to his caregiver in the absence of traditional risk factors. It should be noted that the source had a very high viral load during the terminal phase of his illness.