title: Unexplained HIV-1 infection in children--documenting cases and assessing for possible risk factors.
abstract: BACKGROUND
  In the year 2000 we reported possible horizontal transmission of HIV-1 infection between two siblings. An investigation of three families, each with an HIV-infected child but seronegative parents, permitted this finding. Sexual abuse and surrogate breast-feeding were thought unlikely. The children had overlapping hospitalisation in a regional hospital. Since then several cases of unexplained HIV infection in children have been reported. A registry was established at Tygerberg Children's Hospital for collection of data on the extent of horizontal or unexplained transmission of HIV in children.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  Fourteen children were identified, 12 from the Western Cape and 1 each from the Eastern Cape and KwaZulu-Natal. Thirteen (92%) had been hospitalised previously. In the Western Cape, children had been hospitalised in 8 hospitals. Ten of 13 (77%) were admitted as neonates and 9 of 13 (69%) had 2 or more admissions. Intravascular cannulation and intravenous drug administration occurred in all but 2 children before HIV diagnosis.
  
  
  CONCLUSIONS
  We have confirmed HIV infection in a number of cases where the source of infection has been inadequately explained. Circumstantial evidence supports but does not prove nosocomial transmission. Further studies and identification of medical procedures conducive to the spread of HIV are urgently needed.
authors.affiliation: Department of Paediatrics and Child Health and Tygerberg Children's Hospital, Faculty of Health Sciences, University of Stellenbosch.
authors.forename: R
authors.initials: R
authors.lastname: Hiemstra
authors.forename: H
authors.initials: H
authors.lastname: Rabie
authors.forename: H S
authors.initials: HS
authors.lastname: Schaaf
authors.forename: B
authors.initials: B
authors.lastname: Eley
authors.forename: N
authors.initials: N
authors.lastname: Cameron
authors.forename: S
authors.initials: S
authors.lastname: Mehtar
authors.forename: A
authors.initials: A
authors.lastname: Janse van Rensburg
authors.forename: M F
authors.initials: MF
authors.lastname: Cotton
mesh_terms: D017677:Age Distribution; D002675:Child, Preschool; D003906:Developing Countries; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission*; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006801:Humans; D015994:Incidence; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012698:Serologic Tests; D012720:Severity of Illness Index; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis