A comparison of HIV antibody and HIV viral findings in blood and saliva of HIV antibody-positive juvenile hemophiliacs.

The purpose of this study was to determine the presence or absence of human immunodeficiency virus (HIV) and antiHIV antibody in the saliva of known anti-HIV positive juvenile hemophiliacs and correlate these findings with blood. This study utilized a sample population of 13 juvenile hemophiliacs (severe hemophilia A), all of whom were antiHIV antibo~ly positive. Blood samples, as well as stimulated mixed and parotid saliva, were obtained and subjected to ELISA and Western blot assays as well as electron microscopy. The results show the presence of HIV in the blood of one subject and anti-HIV antibody in all subjects. Neither HIV nor an ti-HIV antibody was detected in whole or parotid saliva of the sample population. It is now accepted that human immunodeficiency virus (HIV), formerly known as human T-cell lymphotropic virus type III (HTLV-III), is the primary cause of the disease acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC) (Chermann al. 1984). The virus attacks the T-helper cells, causing the immune system to function at a much reduced level. With this decreased protection, the human body is susceptible to opportunistic infection or neoplasia (Barre-Sinoussi et al. 1983). HIV virus has been found in a number of body fluids including blood (Groopman et al. 1984), saliva (Groopman et al. 1984), tears (Fujikawa et al. 1985), and semen (Zagury et al. 1984). The finding of HIV virus in human saliva by Groopman et al. (1984) and in saliva and parotid glands of monkeys by Gravell et alo (1984), well as retrovirus-like particles (putatively associated with AIDS) in the salivary glands of AIDS patients by Lecatsas et al (1985) is of considerable importance clinical practitioners of dentistry. Indeed, the discovery of HIV in saliva could possibly present a mode of horizontal transmission of the virus from patient to dentist, dentist to patient, and patient to patient. A study by Friedland et al. (1986) examined the possibility passing the salivary HIV virus via casual contact with household articles; however, no patient contracted the disease by this route. In 1988, however, Klein et al. reported that a dentist had contracted the AIDS virus by treating an AIDS patient. The Groopman et al. (1984) study indicated that the HIV virus was found in the saliva, but did not indicate how the saliva was collected. Therefore, it is assumed that their study was based on whole saliva. Also, in their studies, saliva may have contained occult blood, exfoliated epithelial cells, and microbial contamination. In a study reported by Le Baron and Nehrbass (1986), dental treatment of 217 patients with diagnosed AIDS and 35 patients with ARC was described. Following a treatment time of 17 months, none of the auxiliaries or professional staff became virus or antibody positive for HIV, nor did they develop opportunistic infections during the course of treatment. Ho et al. (1986) reported in a study of parotid saliva samples from 83 patients that one tested positive for HIV antibodies. The Centers for Disease Control (CDC) in Atlanta, Georgia, still contend that the virus is not passed by casual contact (personal communication to Donna Warfield, AIDS Epidemiology Branch, June 1,1987). There are questions, concerning the low incidence of HIV virus in the saliva of infected individuals, and whether or not the virus is in high enough concentrations to bring about a possible transmission threat. Antibodies to HIV have been isolated in whole saliva by Groopman et al. (1984) and parotid saliva by Archibald et al. (1986). As of June 1,1987, there have been 504 cases of AIDS in children under the age of 13 reported to the CDC (personal communication to CDC AIDS Epidemiology Branch). Of these, the putative route of HIV transmission was traced to the following: 25 were found in hemophiliacs; 56 through blood transfusions; 397 were children born to parents at risk for AIDS; and 26 unknown. The CDC does not have statistics of the total Pediatric Dentistry: December, 1988 Volume 10, Number 4 283 number of children who are anti-HIV Ab positive. To date, no studies have been reported utilizing anti-HIV Ab positive children to determine the possibility of HIV transmission via saliva to dental personnel. The purpose of this study was to collect parotid saliva from 13 anti-HIV Ab positive juvenile hemophiliac patients undergoing long-term treatment at the Children’s Hospital of Los Angeles, to determine the presence or absence of HIV virus or anti-HIV antibody in saliva, and to correlate these findings to whole blood. Materials and Methods The present study utilized a population of 13 patients at Children’s Hospital of Los Angeles with severe hemophilia A (patients with less than 2% factor VIII activity) who had received treatment with commercial clotting factor concentrates, and who all became antiHIV Ab positive. The sample population also was known to be hepatitis non-A, non-B, and hepatitis B positive. Ages ranged from 7 to 19 years. The research procedure and informed consent for the study were approved by the institutional research review committee. After the consent form was signed, blood was obtained via venipuncture to determine the status of the HIV infection. Following collection, the blood samples immediately were placed in RPMI-1640 nutrient broth containing phytohemaglutinin (PHA). A clinical dental examination was performed on each subject, noting gingival bleeding or inflammation. A simple gingival index as developed by L6e and Silness (1967), was performed on all subjects. Teeth numbers 3, 5, 10, 15, 19, 21, 26, and 31 were evaluated and the gingival tissue surrounding each tooth was divided into 4 scoring units: distal-facial papilla, the entire facial margin, mesial-facial papilla, and the entire lingual margin. Each section was scored by the follow-