title: Practice of feeding premasticated food to infants: a potential risk factor for HIV transmission.
abstract: OBJECTIVE
  Although some caregivers are known to premasticate food for infants, usually during the weaning period, HIV transmission has not been linked to this practice. We describe 3 cases of HIV transmission in the United States possibly related to this practice.
  
  
  METHODS
  Three cases of HIV infection were diagnosed in children at ages 9, 15, and 39 months; clinical symptomatology prompted the testing. A thorough investigation to rule out alternative modes of transmission was conducted. In addition, phylogenetic comparisons of virus from cases and suspected sources were performed by using the C2V3C3 or gp41 region of env and the p17 coding region of gag.
  
  
  RESULTS
  In 2 cases, the mothers were known to be infected with HIV, had not breastfed their children, and perinatal transmission of HIV had previously been ruled out following US HIV testing guidelines. In the third case, a great aunt who helped care for the child was infected with HIV, but the child's mother was not. All 3 children were fed food on multiple occasions that had been premasticated by a care provider infected with HIV; in 2 cases concurrent oral bleeding in the premasticating adult was described. Phylogenetic analyses supported the epidemiologic conclusion that the children were infected through exposure to premasticated food from a caregiver infected with HIV in 2 of the 3 cases.
  
  
  CONCLUSIONS
  The reported cases provide compelling evidence linking premastication to HIV infection, a route of transmission not previously reported that has important global implications including being a possible explanation for some of the reported cases of "late" HIV transmission in infants, so far attributed to breastfeeding. Until the risk of premastication and modifying factors (eg, periodontal disease) are better understood, we recommend that health care providers routinely query children's caregivers and expecting parents who are infected with HIV or at risk of HIV infection about this feeding practice and direct them to safer, locally available, feeding options.
authors.affiliation: Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA. aditya.gaur@stjude.org
authors.forename: Aditya H
authors.initials: AH
authors.lastname: Gaur
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Dominguez
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Kalish
authors.forename: Delia
authors.initials: D
authors.lastname: Rivera-Hernandez
authors.forename: Marion
authors.initials: M
authors.lastname: Donohoe
authors.forename: John T
authors.initials: JT
authors.lastname: Brooks
authors.forename: Charles D
authors.initials: CD
authors.lastname: Mitchell
mesh_terms: D002675:Child, Preschool; D005260:Female; D015700:HIV Envelope Protein gp41 / Q000235:genetics; D015658:HIV Infections / Q000635:transmission*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D007124:Immunoenzyme Techniques; D007223:Infant; D007225:Infant Food / Q000009:adverse effects* / Q000821:virology*; D008297:Male; D008409:Mastication; D010446:Peptide Fragments / Q000235:genetics; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D054299:env Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D015700:HIV Envelope Protein gp41; D010446:Peptide Fragments; D054299:env Gene Products, Human Immunodeficiency Virus; C473991:p17 gag peptide, human immunodeficiency virus