Failure to Develop HIV Infection After Receipt of HIV-Contaminated Blood and Postexposure Prophylaxis [Katzenstein TL, et al. Ann Intern Med 2000; 133: 31]: This is a case report from Denmark of a 13-year-old who received a transfusion that was subsequently found to be positive for HIV RNA. Postexposure prophylaxis included AZT, 3TZ, and Indinavir; the PI was subsequently changed to nelfinavir due to intolerance of indinavir. The prophylaxis continued for nine months. Studies over the subsequent six months showed no evidence of HIV RNA or DNA.
Comment: The source patient had no exposures to HIV except for a bloody altercation in a gay bar 25 days previously. His HIV infection was identified one week after his blood donation when he was hospitalized with the acute retroviral syndrome. The authors note that this type of bloody battle does not usually represent a risk for HIV infection, but has been previously reported [AIDS 1998; 12: 1928]. At any rate, the rate of HIV transmission with contaminated transfused blood approaches 100%. Prophylaxis in this case was delayed until 50 hours after the transfusion. The patient had the CCR5/CCRR5 genotype, and was consequently susceptible to HIV. The conclusion is that the prophylaxis presumably prevented infection despite the extraordinarily high risk. posted 7/19/2000