LETTER TO EDITOR
|Year : 2008 | Volume
| Issue : 2 | Page : 104
One of the twins escaped from HIV infection: Possibility of transmission through breast milk
Peace HIV Care Center, 7/A1, Railway Station Road, Palayamkottai, Tirunelveli - 627 002, Tamilnadu, India
Peace HIV Care Center, 7/A1, Railway Station Road, Palayamkottai, Tirunelveli - 627 002, Tamilnadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Murugan S. One of the twins escaped from HIV infection: Possibility of transmission through breast milk. Indian J Sex Transm Dis 2008;29:104
|How to cite this URL:|
Murugan S. One of the twins escaped from HIV infection: Possibility of transmission through breast milk. Indian J Sex Transm Dis [serial online] 2008 [cited 2015 Apr 28];29:104. Available from: http://www.ijstd.org/text.asp?2008/29/2/104/48738
One of the binovular twins infected with HIV and the other not infected is unusual when the mother's HIV status, viraemic condition, intra-uterine status, and labor conditions are the same. One such case, I had come across, is worth reporting.
After the mother's demise due to HIV disease and Tuberculosis in 2007, four of her children were investigated. It was found that her second nine-year-old daughter and a six-year-old boy (one of the twins) were reactive for HIV, whereas, the 17-year-old elder sister and the other twin (six-year-old girl) were nonreactive for HIV. The nine-year-old, HIV-reactive girl was asymptomatic with a CD4 count of 320, whereas, her younger brother had tuberculous pleural effusion (TPE) with a CD4 count of 134. He was on both ART drugs (Efavirenz based regimen) and anti-tuberculous drugs as per the Revised National Tuberculosis Control Program (RNTCP) guidelines. The boy was admitted thrice in the pediatric ward of a teaching and tertiary care hospital and had repeated pleural tapings. The mother had all her deliveries at home and never enrolled herself in the 'Prevention of Parent To Child Transmission' (PPTCT) Program. The baby girl among the twins was delivered first. The birth of the baby boy was considered to be precious and was given top priority by the family because of the male preponderance of the society. So the male baby was fed mother's breast milk, while the twin girl who was brought up by her grandmother was given substitute food. The father's HIV status was not known. He deserted his wife and was living with another woman elsewhere. He was not willing to come to the clinic for follow-up and he had children with his second partner also.
As the sex and facial features were different, these could be binovular twins. In our case the first born twin was HIV seronegative and the second born probably had not acquired HIV during delivery but through breast milk.
A study done by James J. Goedert showed that the trip through the cervix and vagina may expose a firstborn twin to large amounts of bloody, HIV-laced secretions. By the time the second twin gets to the birth canal, the sibling has cleared out much of the bloody fluid - and perhaps the HIV as well, hence the twin who lagged behind had a better chance of escaping the viral threat. 
The rate of transmission of HIV through breast milk is around 10 to 16%.  In this case study, as the twin girl baby was neglected and deprived of breast milk, this was the most possible reason for her to escape from HIV infection.
Therefore, it should be stressed that breast feeding is to be strictly avoided in the 'Prevention of Parent to Child Transmission' Program, even in developing countries like ours, if we want to achieve a more successful outcome of the Program. With extra effort, the artificial feeding of babies can be taught to expectant mothers and if needed an uninterrupted supply of artificial food can be ensured to the poor and mothers who cannot afford it. This will help us to achieve the national goal of bringing down the incidence by half within 2010.  Otherwise there is every possibility of the mixed feeding of infants of HIV mothers, which is worse.
| References|| |
|1.||The Free Library by Farlex.Firstborn twin runs higher AIDS risk. Available from http://www.thefreelibrary.com/Firstborn+twin+runs+higher+AIDS+risk.-a011716981. [last accessed on 2009 Jan 31]. |
|2.||Barlette JE, Gallent JE, Medical Management of HIV infection. Baltimore: John Hopkins Medicine; 2007. p. 119-20. |
|3.||Available from: http://www.nacoonline.org/miscellaneous/Prevention_of_Parent_to Child _Transmission/ [last accessed on 2008 Nov 23]. |