In last week’s Morbidity and Mortality Report, the Centers for Disease Control (CDC) confirmed a likely case of female-to-female transmission of HIV. Although such cases are “rare and difficult to ascertain,” laboratory testing confirmed that the strain of the newly infected woman and that of her sexual partner were a 98 percent genetic match.
The Case
The newly infected woman, a 46-year-old Texan, tested negative for HIV in March 2012, when she donated blood plasma. Ten days later, the woman was admitted into the emergency department complaining of a sore throat, fever, and vomiting, among other symptoms. When tested for HIV, her results came back and were again negative.
Antibody tests, or rapid tests, are some of the most common types of HIV tests on the market. They read the amount of antibodies in the blood rather than the virus itself, to ascertain a patient’s HIV status. Antibodies are produced by the immune system when the immune system detects a harmful agent, such as a bacterium or virus. The type of bacterium or virus will trigger the production of a specific antibody. So, if the body produces antibodies that typically respond to the human immunodeficiency virus it is usually a good indicator that the body is infected with HIV. However, it usually takes two to eight weeks after infection for a person to produce enough antibodies to test positive.
Therefore, it wasn’t until 18 days after her emergency department visit when the woman tried to sell her plasma again, that her HIV test came back positive. Several more tests in later weeks confirmed her diagnosis.
The woman and her female partner, a 43-year-old who was diagnosed with HIV in 2008 and had been off ARV treatment for over three years, had been in a monogamous relationship for six months. The couple reported engaging in risky sexual behavior, such as routine unprotected oral and vaginal sex and using insertive toys. The CDC describes the women’s sexual contact as “at times rough to the point of bleeding in either woman.” Additionally, the women reported having unprotected sexual contact during menstruation, which also increases the risk of HIV transmission between women who have sex with women (WSW). Other potential exposures, including tattoos and piercings, injection drug use, and heterosexual sex, were ruled out.
Safe Sex Practices
Although the risk of contacting HIV is much lower between two women, there still is a risk. Certain preventative measures could have helped the women better protect themselves.
The Texas couple reportedly did not receive counseling on safe sex or medical care. Since the 43-year-old went off treatment in 2010, the amount of the HIV virus in her blood, or viral load, likely increased dramatically, thus increasing the risk of passing the virus on to her partner. The U.S. government’s HIV/AIDS website, AIDS.gov, recommends continued ARV treatment and safe sex practices for discordant couples, or mixed-status couples, to best protect themselves or their partners from HIV, as well as other sexually transmitted infections.
