Minimizing the risk of non‐vertical, non‐sexual HIV infection in children – beyond mother to child transmission

Abstract

After witnessing an episode of poor injection safety in large numbers of children in a rural under-resourced hospital in Uganda, we briefly review our own experience and that of others in investigating HIV infection in children considered unlikely to be through commonly identified routes such as vertical transmission, sexual abuse or blood transfusion. In the majority of cases, parents are HIV uninfected. The cumulative experience suggests that the problem is real, but with relatively low frequency. Vertical transmission is the major route for HIV to children. However, factors such as poor injection safety, undocumented surrogate breast feeding, an HIV-infected adult feeding premasticated food to a weaning toddler, poor hygienic practice in the home and using unsterilised equipment for minor surgical or traditional procedures are of cumulative concern.

Horizontal HIV transmission to children of HIV-uninfected mothers: A case series and review of the global literature

“…Published data on the frequency and routes of horizontal HIV transmission to children is limited, although a few studies have reported the prevalence of horizontally acquired HIV in paediatric antiretroviral clinics at 1%, 5% (our clinic) and 4Á8% respectively (Vaz et al, 2010;van Kooten Niekerk et al, 2006;Reid and Van Niekerk, 2009). Despite growing evidence that horizontal HIV transmission to children is not uncommon (with four published studies in South Africa), there is no national registry to document this phenomenon and no advice on its prevention (Cotton et al, 2012;Shisana et al, 2008;Reid and Van Niekerk, 2009;Eley et al, 2003). Similar reports of healthcare-associated and communityacquired HIV transmission from elsewhere in Sub-Saharan Africa, India and Pakistan have been published, highlighting the need to create awareness of this global phenomenon and investigate the likely routes of transmission and identify risky practices (Vaz et al, 2010;Okinyi et al, 2009;Maniar, 2019;ProMED-mail, 2019;Mir et al, 2020).…”

“…Vertical transmission of HIV, either in utero, intrapartum or post-natally through breastfeeding, is the predominant route for acquisition of HIV infection in children (Cotton et al, 2012). Since 2010, there has been an 18% decrease in the incidence of new HIV infections globally (Joint United Nations Programme on HIV/AIDS, 2018).…”

“…Rarely, children born to HIV-uninfected women may acquire HIV by horizontal transmission (Vaz et al, 2010). This may occur through healthcare-associated transmission by infusion of HIVcontaminated blood or blood products, re-use of contaminated needles/syringes or other medical equipment, and ingestion of HIV in expressed breastmilk in neonatal units (Cotton et al, 2012). Alternatively, community-acquired, horizontal HIV transmission may occur following surrogate breastfeeding or 'wet nursing' by a woman with HIV, pre-mastication of food, and sexual abuse (Shisana et al, 2008;Maritz et al, 2011).…”