Vol.2, No.6, 363-365 (2013) Case Reports in Clinical Medicine
Horizontal transmission of HIV infection in an
HIV-exposed child—An avoidable tragedy
Rosemary O. Ugwu
Department of Paediatrics and Child Health, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria;
Received 22 June 2013; revised 23 July 2013; accepted 11 August 2013
Copyright © 2013 Rosemary O. Ugwu. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Exposure to infected blood/blood products
through blood transfusion and use of contami-
nated sharp objects remain an important source
of HIV infection. This report describes the case
of a 52-month-old male child of an HIV-infected
mother in whom perinatal infection was suc-
cessfully prevented by maternal and infant anti-
retroviral therapy, elective cesarean section, and
avoidance of breast-feeding. A DNA PCR test at
6 weeks was negative and a rapid antibody test
at 18 months was seronegative. He presented to
the Paediatric infectious disease unit with chro-
nic fever, cough, diarrhea and weight loss 7
months after receiving a commercially donated
blood (in a rural private hospital) and scarifica-
tion marks (by a traditional healer) for a febrile
illness with convulsion. He was found to be se-
ropositive with severe immunosuppression. He
however died a month after being initiated on
antiretroviral drug.
Keywords: HIV-Exposed; Blood Transfusion;
HIV infection is a preventable disease. The majority of
infections in the paediatric age grou p are through vertical
transmission from an infected mother to the infant [1].
With interventions, using a comprehensive package of
services, including maternal and infant antiretroviral
therapy, elective cesarean section, and avoidance of
breast-feeding, the risk of mother-to-child transmission
(MTCT) can be drastically reduced to less than 5% [2,3].
Occasionally also, children may become infected by
exposure to infected blood through blood transfusion and
use of unsterilized sharp objects. This is a report of a
child in whom perinatal infection was successfully pre-
vented by prevention of mother-to-child strategies but
who later acquired infection by exposure to infected
blood produ cts.
A 52-month-old male was brought to Paediatric infec-
tious disease unit with a 3-month history of recurrent
fever, cough, diarrhea, weight loss and boils. The mother
was diagnosed HIV-positive 4 years before his concep-
tion and has been adherent to her antiretroviral drugs
(zidovudine, lamivudine and nevirapine fixed dose com-
bination). Her CD4 count during pregnancy ranged
between 830 and 1050 cells/µl. He was delivered at term
by elective cesarean section and weighed 3.8 Kg. He
received a single dose nevirapine and zidovudine for 6
weeks and was fed exclusively on breast milk substitute.
A DNA PCR test done at 6 weeks was negative. HIV
rapid diagnostic test (Determine®) at 6 and 18 months
were both seronegative. He remained healthy until at 42
months when he developed a febrile illness with convul-
sion. He was first taken to a traditional healer who made
scarification marks on the abdomen and applied some
herbs. As his condition did no t improve, h e was taken to
a rural private hospital where he was transfused (with
commercially donated blood) for severe anemia second-
ary to severe malaria. Seven months later, he developed
the presenting co mplaints. Physical examination revealed
marked muscle wasting, prominent rib cage, marked loss
of gluteal bulk and a weight of 7.8 Kg (49% of expected).
He had grade 3 finger clubbing and significant gener-
alized lymphadenopathy. He had healed scarification
marks over the right and left hypochondria (Figures 1
and 2). Chest examination revealed bilateral coarse
crepitations. HIV rapid diagnostic tests (Determine® and
Unigold®) were both reactive. His CD4 count was 75
cells/ul and chest radiograph showed bilateral hilar and
perihilar opacities. The mantoux test was negative. He
Copyright © 2013 SciRes. OPEN ACCESS
R. O. Ugwu / Case Reports in Clinical Medicine 2 (2013) 363-365
Figure 1. Anterior view of the patient showing prominent ribs
and scarification marks on the abdomen.
Figure 2. Posterior view of the patient showing marked loss of
gluteal muscle, overhanging skin and prominent pelvic bones.
tested seronegative to Hepatitis B surface antigen and
Hepatitis C virus antibody. He was managed for WHO
clinical stage 4 disease with severe wasting, pulmonary
tuberculosis and severe immunosuppression. He received
antituberculous drugs, cotrimoxazole and ready-to-use
therapeutic feed (Plumpy nut®). After 2 weeks on anti-
tuberculous drugs, he was initiated on antiretroviral drugs
(zidovudine, lamivudine and nevirapine) but died after
one month on antiretroviral drugs.
In the Paediatric age group, mother-to-child (vertical)
transmission accounts for as much as 90% of HIV infec-
tion [1,2]. Children however may become horizontally
infected through exposure to infected blood. This can
occur either through transfusion with infected blood or
by use of contaminated sharp objects. Blood/blood pro-
ducts remain an important source of HIV infection. Most
blood transfusion-transmitted HIV infection result from
transfusion with unscreened/improperly screened blood
[4]. Although tremendous progress has been made in
reducing the risk of HIV transmission from blood trans-
fusion through careful donor selection criteria and better
laboratory testing of each donated unit of blood [5],
blood screening facilities are still grossly lacking in most
areas in developing countries. Most blood donations are
done commercially for economic gains, so that trans-
fusion with an improperly screened blood remains a
possibility. Despite these better blood screening proce-
dures, HIV transmission may still occur if the blood
donation occurred during the window period (when the
blood of a newly infected person does not show up as
positive on screening tests) [6-8], if the potential blood
donor is infected with variant strains of HIV that may
escape detection by current screening assays or following
testing or documentation errors [7]. Almost all recipients
of HIV-positive unit of blood/blood product will develop
HIV-infection [8,9], and will manifest with symptoms of
AIDS within a shorter incubation time especially in
young children [1 0].
Cultural practices like circumcision and scarification
are commonly performed in children and involve the use
of shared and non-sterile instruments with traditional
healers and since these practices result in exposure to
blood, they present potential avenues for transmission of
HIV to children [11]. In many African countries with
limited access to formal/western health care services,
traditional healers are usually the first port-of-call and
the main source of primary health care needs [12,13].
Circumcised and scarified children are more likely to be
infected with HIV than children who had not been cir-
cumcised or scarified [14]. Body scarification as prac-
ticed in many ethnic groups not only involves the use of
shared unsterilized and contaminated instruments but
also the application of substances (which may be con-
taminated by blood from a previous HIV-positive client)
into the freshly made wounds. The traditional healers
themselves may also be HIV infected from the various
scarification marks they have made for clients most often
with ungloved hands. All these increase the risk of HIV
It is however difficult to conclude in this case the ac-
tual source of the infection as both risky exposures oc-
curred at the same time and neither the blood donor nor
the traditional healer cou ld be tracked.
While efforts are made towards reducing MTCT of
HIV, it is equally important to warn parents about all
risks of blood-borne HIV transmission. Transfusion with
questionably screened blood and cultural practices that
expose children to objects possibly contaminated with
Copyright © 2013 SciRes. OPEN ACCESS
R. O. Ugwu / Case Reports in Clinical Medicine 2 (2013) 363-365
Copyright © 2013 SciRes. OPEN ACCESS
infected blood sho uld be vigorously disc o uraged.
The author is grateful to the mother for granting permission for the
case to be published.
[1] Morison, L. (2001) The global epidemiology of HIV/
AIDS. British Medical Bulletin, 58, 7-18.
[2] Buchanan, A.M., and Cunningham, C.K. (20 09) Advances
and failures in preventing perinatal human immunodefi-
ciency virus infection. Clinical Microbiology Reviews, 22,
493-507. doi:10.1128/CMR.00054-08
[3] Eneh, A.U. and Ugwu, R.O. (2011) Evaluation of the ef-
fecttiveness of the prevention of mother-to-child trans-
mission (PMTCT) interventions in HIV-exposed children.
Port Harc ourt Medical Journal, 5, 121-129.
[4] Adejuyigbe, E.A., Durosinmi, M.A., Onyia, F.N. and
Adeodu, O.O. (2003) Blood transfusion related paediatric
HIV/AIDS in Ile-Ife, Nigeria. AIDS Care, 15, 329-335.
[5] Zou, S., Dorsey, K.A., Notari, E.P., et al. (2010) Preva-
lence, incidence, and residual risk of human immunodefi-
ciency virus and hepatitis C virus infections among
United States blood donors since the introduction of nu-
cleic acid testing. Transfusion, 50, 1495-1504.
d oi:1 0.1111/ j.15 3 7-2995.2010.02622.x
[6] Ward, J.W., Holmberg, S.D., Allen, J.R., et al. (1988)
Transmission of human immunodeficiency virus (HIV)
by blood transfusion, screened as negative for HIV anti-
body. New England Journal of Medicine, 318, 973-978.
[7] Kostman, J.R. (2002) Testing for the virus. In: Buckley,
R.M. and Gluckma n, S.J., Eds., HIV Infection in Primary
care, WB Saunders, Philadelphia, 20-23.
[8] Phelps, R., Robbins, K., Liberti, T., et al. (2004) Win-
dow-period human immunodeficiency virus transmission
to two recipients by an adolescent blood donor. Transfu-
sion, 44, 929-933. d o i:1 0.1111/ j.1537-2995.2004.03364.x
[9] Donegan, E., Stuart, M., Niland, J.C., et al. (1990) Infec-
tion with human immunodeficiency virus type 1 (HIV-1)
among recipients of antibody—Positive blood donations.
Annals of Internal Medicine, 113, 733-739.
[10] Medley, G.F., Anderson, R.M., Cox, D.R. and Billard, L.
(1987) Incubation period of AIDS in patients infected via
blood transfusion. Nature, 328, 719-721.
[11] Hardy, D.B. (1987) Cultural practices contributing to the
transmission of human immunodeficiency virus in Africa.
Review of Infectious Diseases, 9, 1109-1119.
[12] World Health Organization (WHO) (2008) Traditional
[13] Pretorius, E. (2000) Traditional healers. In: Crisp, N. and
Ntuli, A., Eds., South African Health Review 1999, Health
Systems Trust, Durban, 249-256.
[14] Brewer, D.D. (2011) Scarification and male circumcision
associated with HIV infection in Mozambican children
and youth. WebmedCentral EPIDEMIOLOGY, 2, WMC