HIV Transmission Through Premastication

Premastication is a potential route of transmission of HIV from caregiver to child. We report the case of a 13-month-old Alaska Native child from rural Alaska who presented with failure to thrive, recurrent pneumonias, severe dental decay, and dysphagia. The mother was HIV-uninfected. Respiratory failure prompted transfer to a children's hospital outside of Alaska where the child received a diagnosis of HIV infection. A grandparent who had been acting as primary caregiver was discovered to be HIV-infected with detectable viral load resulting from intermittent nonadherence to her medication regimen. This grandparent reported feeding the child premasticated food. Sequencing of the hypervariable C2V5 region of the HIV envelope gene in both patients demonstrated less than 0.05% variation, consistent with transmission from grandparent to child. Health care providers should be aware that transmission of HIV can occur via premastication, educate parents and caregivers regarding this risk, and rigorously pursue HIV testing when indicated even in children with HIV-uninfected mothers.

Automated summary

This case report highlights the potential transmission of HIV from caregiver to child via premastication. A 13-month-old child from rural Alaska presented with several health issues and was diagnosed with HIV infection after being transferred to a children's hospital outside of Alaska. The primary caregiver, a grandparent, was found to be HIV-infected with detectable viral load. Sequencing of the HIV envelope gene showed a close similarity between the virus in the grandparent and the child. Health care providers should be aware of the possibility of HIV transmission through premastication and educate parents and caregivers about this risk, even if the child's mother is HIV-uninfected.