Premastication as a route of pediatric HIV transmission: case-control and cross-sectional investigations.
BACKGROUND
Three cases of pediatric HIV transmission attributed to the feeding practice of premasticating food for children have been reported. The degree of risk that premastication poses for pediatric HIV transmission and the prevalence of this behavior among HIV-infected caregivers is unknown.


METHODS
During December 2009 to February 2010, we conducted a case-control investigation of late-diagnosed HIV infection in children at 6 HIV clinics using in-person and telephone interviews. A cross-sectional investigation of premastication was conducted in concert with this case-control investigation.


RESULTS
We compared 11 case-patients to 35 HIV-exposed controls of similar age. Sixteen (35%) of 46 children were fed premasticated food, 10 (22%) by an HIV-infected caregiver. Twenty-seven percent of case-patients received premasticated food from an HIV-infected caregiver compared with 20% of controls (odds ratio = 1.5; 95% confidence interval = 0.3 to 7.1). In the cross-sectional investigation, 48 (31%) of 154 primary caregivers of children aged ≥6 months reported the children received premasticated food from themselves or someone else. The prevalence of premastication decreased with increasing caregiver age and had been used to feed children aged 1-36 months.


CONCLUSIONS
Premastication, a potential route of HIV transmission to children, was a common practice of caregivers. Public health officials and health care providers should educate the public about the potential risk of disease transmission via premastication.
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ibw4@cdc.gov
Wade
W
Ivy
Kenneth L
KL
Dominguez
Natella Y
NY
Rakhmanina
Angela D
AD
Iuliano
Susan P
SP
Danner
Craig B
CB
Borkowf
Anitra P
AP
Denson
Aditya H
AH
Gaur
Charles D
CD
Mitchell
Sheryl L
SL
Henderson
Mary E
ME
Paul
Theresa
T
Barton
Mary
M
Herbert-Grant
Shannon L
SL
Hader
Eileen
E
Pérez García
Jessica L
JL
Malachowski
Steven R
SR
Nesheim
D000328:Adult; D016022:Case-Control Studies; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005247:Feeding Behavior; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007223:Infant; D007225:Infant Food; D008297:Male; D008409:Mastication; D008875:Middle Aged; D011647:Puerto Rico; D014481:United States; D055815:Young Adult