Lesbian transmission of HIV: a rare case reported

A rare case of female-to-female sexual transmission of HIV is reported in the online edition of the journal Clinical Infectious Diseases, due to be published on 1st February 2003. Doctors suggest the woman may have been infected through sharing sex toys after drug resistance tests found striking similarities between the genotypes of the woman and her female HIV-positive partner.

The case concerns a 20 year old woman, from Philadelphia, who presented with HIV infection having had a negative HIV test result six months earlier. The woman had been in a monogamous lesbian relationship for the past two years, and denied having had any other sexual partners, male or female. She had never injected drugs or received blood products, and had no tattoos or body piercings.

The couple’s sexual practices included the sharing of sex toys, and oral sex. These activities did not occur during menstruation, but sex toys had occasionally been used vigorously enough to draw blood.

Glossary

oral

Refers to the mouth, for example a medicine taken by mouth.

drug resistance

A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs because of an accumulation of HIV mutations in its genotype. Resistance can be the result of a poor adherence to treatment or of transmission of an already resistant virus.

discordant

A serodiscordant couple is one in which one partner has HIV and the other has not. Many people dislike this word as it implies disagreement or conflict. Alternative terms include mixed status, magnetic or serodifferent.

oral sex

Kissing, licking or sucking another person's genitals, i.e. fellatio, cunnilingus, a blow job, giving head.

A medical examination established that the woman was in good health with no evidence of injecting drug use, or nasal damage from cocaine snorting. The woman also had good oral health, which physicians took to mean that oral transmission could be ruled out.

Her bisexual partner was known to be HIV-positive, and is believed to be the source of infection because of similarities observed when the two women underwent genotypic drug resistance tests. The 20 year old woman was infected with multi-drug resistant HIV, which carried the following mutations: T215Y (associated with resistance to AZT, d4T and abacavir), D30N (associated with resistance to nelfinavir), K103N (associated with resistance to NNRTIs), L63P (a polymorphism), V77I (also a polymorphism), and M41L (associated with resistance to AZT and d4T, and with resistance to other NRTIs in the presence of T215Y). Her partner’s genotype carried mutations at each of these points, plus M184V (associated with resistance to 3TC).

The investigators note that this is the "first reported case of female-to-female sexual transmission of HIV supported by identification of similar HIV genotypes in the source patient and the recipient."

They conclude that whilst reports of woman-to-woman sexual transmission of HIV are scarce, lesbians in HIV-discordant relationships should be advised regarding safer sexual practices.

References

Kwakwa HA et al. Female-to-female transmission of human immunodeficiency virus. Clinical Infectious Diseases, 36, 1 February 2003.