16 year old HIV+ patient without risk factors
I recently had a patient diagnosed with HIV. The patient was 16 years old and had no risk factors. She had never had sex or used any illicit drugs. However, her mother has also been HIV+ for the past four years. I would like to know where to start looking for information about in-utero transmission of HIV that's not detected until years later.
Thank you for your question.
Sometimes when a person tests HIV positive, we initially are not able to determine how they became infected. But very often, when we investigate further, we do discover how the person actually did became infected.
In a situation such as this, there are several possibilities as to how she became infected:
If her mother was infected at the time of her birth, this teenager may have been born already infected with HIV. Although having the virus for 16 years would be unlikely (without already having shown symptoms of HIV/AIDS), such a possibility cannot be completely ruled out. In a case such as this, the child would have had a reliable antibody test at 18 months of age or older. If this child had a negative antibody test at 18 months of age or older, but tests positive now, the chances of her being born with HIV are highly unlikely.
The teenager may have been directly exposed to the mothers blood. This may have occurred if she gave her mother first aid, shared needles with her mother, or another type of direct blood-to-blood contact.
The teenager may have had a needle or sexual exposure that she is not telling you about. It is quite common for a person to not initially tell you their risk factors for HIV. This is often due to a person feeling uncomfortable talking about their risk factors. In addition, issues like fear, shame, embarrassment talking about sexual or drug issues, fear of arrest (if a person has a history of IV drug use), etc., may also make her hesitant in discussing her risk factors with you. At this point, you cannot assume she became infected from her mother. She may have had her own risk factors for HIV that she has not told you about thus far, that did not involve her mother.
The next step is to talk to her again to further investigate her risk factors. Your local health department may be able to help you do this.
If you have any further questions, please feel free to call the Centers for Disease Control at 1.800.232.4636 (Nationwide).