Father to child transmission of human immunodeficiency virus disease while sero-discordant status of the mother is maintained.

Sir,

Human immunodeficiency virus (HIV) is known to be transmitted primarily through the sexual route.[1] Initially the cell free virus and the seminal leukocyte were considered to be the sole source responsible for the sexual transmission of HIV as sexually transmitted infections (STIs) are often associated with high seminal leukocytes and STI is one of the high risk factors associated with HIV transmission. However, subjects with low seminal leukocyte count and absence of STI are also known to acquire HIV infection. Here plays the concept that the spermatozoa themselves can carry the HIV to the target cell.[2] Herewith we want to record a case of a child acquiring the HIV infection directly from the father, possibly the spermatozoa as a carrier without infecting the mother.

A 33-year-old man, with HIV infection was admitted for renal problem in our community care center. His wife was persistently non-reactive for HIV (Three consecutive examinations at three different voluntary counseling and testing centers and also with HIV western blot test). The man has three children and the youngest male, 5 years old, was the only reactive child for HIV in their family apart from the father. No history of blood transfusion or surgery or sex abuse in this child, as per their parents, was elicited.

Scanty or absence of human mannose receptors (hMRs) in the vaginal epithelium is one of the causes for the sero-discordant state.[3] As the mother is sero-negative, mother to child transmission was not likely in this case. Spermatozoa are known to be a risk factor for the sexual route of transmission of HIV. It was demonstrated by the Argentinean scientists who proved that spermatozoa could lead from front to transmit HIV-1. They had well documented evidence that sperm, and not the fluid it bathes in, can transmit the HIV-1 to dendritic cells and macrophages.[4] The powerful technique of atomic force microscopy had been employed to examine the localization of HIV on the spermatozoa of HIV infected patients.[5] Bagasra et al.[2] have localized HIV deoxyribonucleic acid in the ejaculated spermatozoa of infected individuals by in situ polymerase chain reaction. The hMR on the spermatozoa had been shown to be responsible for the sexual transmission of HIV. It was demonstrated for the 1st time that HIV binds specifically to hMR and enters into the sperm which may transmit into the distal cells and therefore, the sperm associated virus is a risk factor for sexual transmission of HIV.[67] It has also been reported that HIV infected spermatozoa have the ability to fertilize the oocytes and transfer the virus into the resulting embryo, but the cell free virus in the semen is not able to bind or penetrate the oocyte in vitro.[8]

So one should also think of the possibility of direct transmission of HIV from father to a child where sperm acts as a carrier and to screen all children for HIV even if the mother is not reactive for HIV and if any one of the parent is having the HIV infection.