HIV-1 INFECTION DESPITE IMMEDIATE COMBINATION ANTIVIRAL THERAPY AFTERINFUSION OF CONTAMINATED WHITE CELLS

We present a sixth human case in which primary human immunodeficiency virus (HIV-1) infection occurred, despite antiretroviral prophylaxis, after accidental inoculation of infected blood. In the prior five inst ances, variables such as large virus dose, late administration of anti virals, viral resistance to zidovudine, and pre-existent immunosuppres sion, may have played a role in the treatment failure. In this case, h igh-dosage oral zidovudine was given within minutes of the accident an d replaced 21/2 days later with interferon alpha and dideoxyinosine (d dl). Despite aggressive treatment, HIV-1 infection was demonstrated in blood, spleen, and brain tissue at autopsy 16 days later. Of thee tis sues studied, detection of HIV-1 was most prominent in the spleen. Dou ble-label immunocytochemistry confirmed the morphologic impression tha t while some of the infected spleen cells were CD3-positive T cells, t he majority were macrophages. Thus, current single or dual (zidovudine , ddl-interferon) therapies for accidental HIV-1 inoculation may not b e effective in preventing early infection. Further trials in animals a ppear warranted to evaluate protection by other strategies, such as pa ssive immunity or combinations of agents that penetrate the brain and attack HIV-1 viral replication at differing sites.