Transmission of HIV-1 from an obstetrician to a patient during a caesarean section

Abstract

We have recently reported [1] a probable case of the transmission of HIV-1 from an obstetrician to a patient during a caesarean section. In response to a request from the editors for clarification of the HIV testing that took place and in response to a reader's query, so that others are aware of the details available on this report of HIV transmission between a healthcare professional and a patient, we would like to underline and or reinforce the following points: (i) The HIV-negative test during pregnancy was reported by the patient only, and any results for screening for HIV-1 antibodies and viral load could not be directly verified. There was, however, a fully verified HIV-negative test report from the laboratory of the blood bank of our institution for a blood donation sample taken approximately 3 months before pregnancy; (ii) The newborn was HIV antibody negative immediately after the caesarean section and the viral load was undetectable; (iii) According to our medical records on the obstetrician, he had not been tested previously for HIV before the caesarean section. The first time he reported to us to be tested (the test was positive) for HIV was in September 2001 (7 months after the caesarean section); (iv) The needlestick injury was reported by the patient, and this was seen by the patient and her relatives, and the obstetrician was said to have admitted the accident to the patient and her relatives but not directly to us; and (v) The summary of the dates the blood samples were taken and the results are as follows: On 20 March 2000 on the occasion of a blood donation at our institution, the HIV serology of the patient (enzyme-linked immunosorbent assay test) was negative. Around June–July 2000 the pregnancy was diagnosed. Routine pregnancy screening tests including HIV serology were performed at another hospital and were reported to be negative to the patient by her obstetrician. On 1 February 2001 delivery by caesarean section took place. A needlestick accident happened during the caesarean section. HIV antibodies of the newborn were negative and the HIV viral load of the newborn was undetectable. On 13 March 2001 the patient developed clinical manifestations consistent with an acute HIV infection. On 29 March 2001 the patient had for the first time an HIV-positive serology. In September 2001 an HIV test on the obstetrician was positive. No previous tests were available or at least none were reported to us. On 21 January 2002 a blood sample was drawn from the obstetrician and the patient in the setting of a legal litigation. HIV sequence analysis performed in our laboratory demonstrated that the viruses were almost identical. A duplicate test was performed in the Hospital Germans Trías i Pujol (Badalona, Barcelona) also showing the virtual identity of both viruses. After carefully re-reviewing of all these data we strongly believe that the main conclusion of the paper (‘highly likely HIV-1 transmission from an obstetrician to a patient during a caesarean section’) remain unchanged or even further reinforced.