Report of a Patient Treated with Anti-HIV Drugs after Receiving HIV-Contaminated Blood Who Did Not Develop HIV Infection

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The summary below is from the full report titled "Failure To Develop HIV Infection after Receipt of HIV-Contaminated Blood and Postexposure Prophylaxis." It is in the 4 July 2000 issue of Annals of Internal Medicine (volume 133, pages 31-34). The authors are T.L. Katzenstein, E. Dickmeiss, H. Aladdin, A. Hede, C. Nielsen, H. Nielsen, L.B. Jørgensen, and J. Gerstoft.

What is the problem and what is known about it so far?

The ability to test donated blood for human immunodeficiency virus (HIV) and routine testing has greatly decreased the risk for getting HIV infection from blood transfusions. However, there is a lag of about 3 weeks between the time a person gets infected with HIV and the time when the HIV test becomes positive. Thus, it is possible (but extremely rare) that donated blood could contain the virus even though the HIV test does not yet show it. It is also likely that treatment of patients with anti-HIV drugs immediately after they are exposed to the virus can decrease the chance that they will actually become infected. However, the protective effect of such early treatment has not yet been clearly proven.

Why did the researchers do this particular study?

The authors wanted to report the outcome of a patient who was treated with powerful anti-HIV therapy soon after receiving a blood transfusion from a person with very early HIV infection.

Who was studied?

A 13-year-old girl in Denmark who received a blood transfusion contaminated with HIV and the man who had donated the blood used in the transfusion.

How was the study done?

The man who donated the blood developed a fever and rash that doctors diagnosed as acute HIV infection. This diagnosis was confirmed by finding high levels of the virus in his blood. The man began taking anti-HIV treatment and told his doctors that he had donated blood 1 week earlier. By tracing the donated blood, the doctors found that it had been used in a transfusion given to a 13-year-old girl during a surgical procedure. The HIV test of the transfused blood was negative, suggesting no HIV infection, but special laboratory tests showed that the blood contained substantial amounts of the virus. The girl immediately began taking powerful anti-HIV drugs (zidovudine, lamivudine, and indinavir), which were continued for 9 months. The doctors had planned to continue the drug therapy for 1 year, but the girl developed side effects that required stopping treatment.

What did the researchers find?

During the 9 months that she took the anti-HIV drugs, the girl who received the contaminated transfusion did not develop HIV infection. Even 6 months after stopping anti-HIV therapy, no HIV was found in her blood.

What were the limitations of the study?

This study reports only one case, which makes it difficult to know for certain that it was the anti-HIV drugs that prevented the girl from getting HIV infection.

What are the implications of the study?

Immediate therapy with powerful anti-HIV drug should be considered for persons who have recently been exposed to blood contaminated with HIV.