Cases: Unexpected HIV Infections

All too often, HIV tests find people with unexpected infections – children with HIV-negative mothers, virgin youth, and adults with no sexual risks for HIV. In this section, each country page lists information on unexpected infections from personal accounts, newspapers, journals, and other sources. Because governments and newspapers ignore most unexpected infections, this is a woefully incomplete list. But it is a start.

We invite readers to report unexpected HIV infections from newspapers, journals, or personal experience. Please report cases in a way that protects the confidentiality of people with HIV. However, if you have an unexpected infection, and you choose to disclose your name, we will follow your wishes.

Unexpected infections reported in Africa (countries in alphabetical order): Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo (Brazzaville), Cote d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe.

Unexpected infections reported outside Africa (selected countries in alphabetical order): Australia, China, Denmark, India, Kazakhstan, Kyrgyzstan, Libya, Mexico, Pakistan, Romania, Russia, Uzbekistan

From cases to investigations: There are two ways for governments to react to unexpected infections (cases).

Investigate: The right way is to try to find the source of the infection. Ask where the infected person might have been stuck with HIV-contaminated instruments – did he/she get stuck at a clinic, hair salon, or other facility? Then trace and test others visiting the same clinic or facility to see how many, if any, others were infected from the same source.

Don’t investigate: The wrong way to react is to ignore it. Unexpected infections are evidence that something is wrong. If no one investigates smoke, the house might burn down. If a doctor or nurse unintentionally infects one patient with HIV through reused bloody gloves or equipment, it’s very likely they infect others, too. If no one looks to find others who have been infected, and to find the source, how will anyone know what is dangerous, what to change, what to avoid? Dangerous procedures will continue to infect more people.

No African government has investigated any unexpected HIV infection. In contrast, ministries of health in Russia, Romania, Libya, Kazakhstan, and other countries have investigated unexpected infections (see Table: Investigated HIV outbreaks) to find hundreds to thousands of infections from medical instruments reused without sterilization. Investigations stopped unsafe practices. No country that has investigated unexpected infections has a generalized epidemic.

Table: Investigated HIV outbreaks from blood-to-blood transmission*

Country, year of outbreak	Who was infected	Number of cases
Mexico, circa 1986[i]	Blood and plasma sellers	281
Russia, Elista, 1988-89[ii][iii][iv][v]	Inpatient children	>260
Romania, 1987-1992[vi][vii][viii]	Children	~10,000
India, Mumbai, 1988[ix]	Blood and plasma sellers	~172
China, 1990-95[x][xi][xii]i	Blood and plasma sellers	~100,000
Libya, 1997-99[xiii][xiv]	Inpatient and outpatient children	>400
Kazakhstan, 2006[xv][xvi]	Inpatient children	>140
Kyrgyzstan, 2007[xvii][xviii][xix]	Inpatient children	>140
Uzbekistan, 2008[xx]	Inpatient children	>140

* Outbreaks with 100 or more infections.

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[i]Avila C, Stetler HC, Sepúlveda J, et al. The epidemiology of HIV transmission among paid plasma donors, Mexico City, Mexico. AIDS 1989; 3: 631-3.

[ii] Bobkov A, Garaev MM, Rzhaninova A, et al. Molecular epidemiology of HIV-1 in the former Soviet Union: analysis of env V3 sequences and their correlation with epidemiologic data. AIDS 1994; 8: 619-624.

[iii] Pokrovskii VV, Eramova II, Deulina MO, et al. An intrahospital outbreak of HIV infection in Elista [in Russian]. Zh Microbiol Epidemiol Immunobiol 1990, 4: 17-23.

[iv] Pokrovsky VV. Localization of nosocomial outbreak of HIV infection in southern Russia in 1988-89. 8th Int Conf AIDS, Amsterdam 19-24 July 1992; abstract no. PoC 4138.

[v] Sauhat SR, Kotova EA, Prokopenkova SA, et al. Risk factors for HIV transmission in hospital outbreak. 8th Int Conf AIDS, Amsterdam 19-24 July 1992, abstract no. PoC 4288.

[vi] Patrascu IV, Dumitrescu O. The epidemic of human immunodeficiency virus infection in Romanian children. AIDS Res Hum Retroviruses 1993; 9: 99-104.

[vii] Apetrei C, Loussert-Ajaka I, Collin G, et al. HIV type 1 subtype F sequences in Romanian children and adults. AIDS Res Hum Retroviruses 1997; 13: 363-5.

[viii] Drucker E, Apetrei C, Heimer R, et al. The role of unsterile injections in the HIV pandemic. In Sande MA, Volberding PY, Lange J, et al. Global HIV/AIDS Medicine. Philadelphia: Saunders, 2007. pp. 755-67.

[ix] Bhimani GV, Gilada IS. HIV prevalence in people with no fixed abode – A study of blood donorship patterns and risk determinants. 8th Int Conf AIDS, Amsterdam 19-24 July 1992; abstract MoC00937.

[x] Wu Z, Liu Z, Detels R. HIV-1 infection in commercial plasma donors in China [letter]. Lancet 1995; 346: 61-2.

[xi] Wu Z, Rou K, Detels R. Prevalence of HIV infection among former commercial plasma donors in rural eastern China. Health Policy Plan 2001; 16: 41-6.

[xii] Ministry of Health, China, UNAIDS, WHO. 2005 Update on the HIV/AIDS epidemic and response in China. Geneva: WHO, 2006.

[xiii] Visco-Comandini U, Cappiello G, Liuzzi G, et al. Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi, Libya. AIDS Res Hum Retroviruses 2002; 18: 727-32.

[xiv] de Oliviera T, Pybus OG, Rambaut A, et al. HIV-1 and HCV sequences from Libyan outbreak. Nature 2006; 444: 836-7.

[xv] Kazakhstan: more HIV-infected children found in southern Kazakhstan. RadioFreeEurope/RadioLiberty, 3 October 2007. Available at: http://uqconnect.net/signfiles/Archives/SIGN-POST00405.txt (accessed 10 October 2007).

[xvi] In the courts: Health workers sentenced to prison in Kazakhstan for criminal negligence after HIV outbreak among women, children. Kaisernetwork.org, 2 January 2008. Available at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=49564 (accessed 27 March 2009).

[xvii] Shersen D. Kyrgyzstan: Officials grapple with HIV outbreak. EurasiaNet, 30 October 2007. Available at: http://uqconnect.net/signfiles/Archives/SIGN-POST00419.txt (accessed 1 November 2007).  

[xviii] Thome C, Ferencic N, Malyuta R, Mimica J, Niemiec T. Central Asia: hotspot in the worldwide HIV epidemic. Lancet Infect Dis 2010; 10: 479-488.

[xix] AP/Houston Chronicle examines HIV outbreak among 72 children, 16 mothers through tainted blood and used needles. Kaisernetwork.org, 11 April 2008. Available at:

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=51472 (accessed 27 March 2009).

[xx] Thome C, Ferencic N, Malyuta R, Mimica J, Niemiec T. Central Asia: hotspot in the worldwide HIV epidemic. Lancet Infect Dis 2010; 10: 479-488.