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Possible Transmission of Human Immunodeficiency Virus to a Patient During an Invasive Dental Procedure
Arch Dermatol. 1990;126(12):1553-1555.
References
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23. CDC. Guidelines for prevention of transmission of human immunodeficiency virus and hepatitis B virus to health-care and public safety workers. MMWR 1989;38(no.S-6) *Single copies of this article will be available free until July 27, 1991, from the National AIDS Information Clearinghouse, P.O. Box 6003, Rockville, MD 20850; telephone (800) 458-5231. * Viral sequences obtained from the samples taken from the dentist and the patient were judged to be closely related by the following criteria: 1. Individual consensus sequences deduced from single base substitutions (excluding insertions and deletions) in the patient's and dentist's viral sequence sets over the V3-V4-C3-V5 regions of the envelope gene differed by 1.2%. Corresponding DNA regions from 17 other distinct North American isolates gave pair-wise differences to the dentist's consensus viral sequence of 5.1% -10.2%, with an average of 8.1%. Similarly, comparison of the patient's consensus viral sequence to these 17 gave pair-wise differences of 5.9% -10.7%, with an average of 8.8%. The range of all pair-wise differences among the 17 was 4.7%-12.9%, with an average of 9.2%. 2. Unique patterns of nucleotide substitutions not found in any other virus isolate examined were shared between viral sequences found in the dentist and patient. 3. The average difference (4.6% ) between all of the patient's viral sequences and all of the dentist's viral sequences over the V4-C3-V5 regions falls into a class of differences (3.4%-5.8%) similarly determined for viruses from known epidemiologically linked cases (2; Los Alamos National Laboratory, unpublished data). These include two instances of sexual transmission, one instance of perinatal transmission, and an instance in which a group of persons with hemophilia became infected from a single batch of factor VIII concentrate. ** Viral sequences obtained from the samples taken from the dentist and the patient were shown to be distinct by the following criteria: 1. Each PBMC sample was split into two before extraction of DNA. PCR amplification of human leukocyte antigen (DQ alpha) sequences was performed on each sample. The sequences were the same between samples from the same person, but the dentist and patient DNA samples were clearly different. 2. The average difference (4.6%, range: 2.0%-7.2%) between all viral V4-C3-V5 sequences present in the patient versus all those in the dentist was higher than the average difference between the viral sequences present within the dentist alone (3.5%, range: 1.2%-6.0%) and within the patient alone (2.0%, range: 0.4%-3.6%). 3. Viral sequences in the patient possessed some unique substitutions not found in the viral sequences from the dentist, and vice versa.
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