A 22-year-old Brazilian woman who was recently diagnosed with HIV may have contracted the virus from sharing unsterilized manicure equipment with her HIV positive cousin, a new case study is reporting.
The woman, who tested positive last year after donating blood for the first time, had no history of transmission risk factors, which prompted medical professionals to delve into her history to identify any possible routes of infection. She denied ever having sex, which was confirmed by a gynecological examination, and her boyfriend of two years tested negative. Her mother was also negative, and was confirmed to be her biological mother. The woman had also never received a blood transfusion or surgery of any kind, nor did she have any piercings or tattoos, according to the report in AIDS Research and Human Retroviruses.
After being diagnosed, it was revealed that the woman had a high viral load and a low white blood cell count, indicating that she was in an advanced stage of the disease. After discussing past events, it was discovered that the woman shared manicure equipment, including cuticle scissors, with an HIV positive cousin when she was 12 years old. Although the relative, who was a manicurist, knew she was infected as she was diagnosed 17 years ago, she did not share her status with her cousin.
With no other leads, the researchers decided to pursue this possibility and sequenced the viral genomes of both women. This revealed that the viruses were highly similar, indicating that they shared a common origin. Furthermore, when they traced the viral sequences back in time, they found that the estimated common ancestor date corresponded with the same year that they shared the tools.
Although it’s impossible to be certain, the absence of any other possible route of transmission married with the strong similarities between the viruses does seem to indicate that the likely cause was the sharing of manicure paraphernalia. This is certainly not a common route of infection, but it could have been facilitated by the fact that the cousin was not on antiviral medication when the equipment was shared, meaning that she probably had lots of virus in her blood. When patients are taking antiviral drugs, the viral load usually drops down to undetectable levels, meaning the risk of transmission is extremely low.
The CDC currently lists tattooing, acupuncture and piercing as possible alternative sources of HIV infection, but manicure equipment is not included in the list. Although this is an extremely rare case, other viruses can also be transmitted from unclean beauty equipment, such as hepatitis C.
This case serves as a stark reminder that people need to get tested for HIV, whether they think that they have engaged in risky behavior or not. In the US, it is estimated that almost 170,000 people are living with HIV but don’t know they are infected. In the UK, around 26,000 don’t know they have the virus.
