Question

Response Questions Part A T。C. Use Only Information Below A. In addition to the dentist and patients A through G, why were 35 local HIV seropositive people included in this study? B. Of patients A through G, which ones had known risk factors for contracting HIV? What were some of the known risk factors at the time (realizing that this was the late 1980s when AIDS/HIV was first discovered)? How was it initially determined that patients E and F contracted their HIV infections from different sources? C. Molecular Epidemiology of HIV Epidemiologic Investigation Transmission in a Dental Practice ioman with ADS (patient A) had mot likely acquired her HIV-1 infection while undergoing invasive dental procedures by a Chin-Yih Ou, Carol A. Ciesielski, Gerald Myers, Claudiu . Bandea, Chi-Cheng Luo, Bette T. M. Korber, James . Mullins, Gerald Schochetman, Ruth L. Berkelman A. Nikki Economou, John J. Witte, Lawrence J. Furman, Glen A. Satten, Kersti A. Maclnnes, James W. Curran, Harold W. Jaffe, Laboratory Investigation Group,* Epidemiologic Investigation Groupt Florida dentist with AIDS (4). Following publication of the report, the dentist pub- licly requested that his former patients be tested for HIV infection. Among approxi- mately 1100 persons whose blood was tested by the Florida Department of Health and Rehabilitative Services (HRS), two pa- tients (patients B and C) were found to be HIV-positive. An additional infected pa Human immunodeficiency virus type 1 (HIV-1) transmission from infected patients to tient (patient D) was ascertained by HRS health-care workers has been well documented, but transmission from an infected healththrough cross matching a list of the dentist's care worker to a patient has not been reported. After identification of an acquired immu ormer patients with the Florida AIDS case nodeficiency syndrome (AIDS) patient who had no known risk factors for HIV infection but registry. Two other patients of the dentist who had undergone an invasive procedure performed by a dentist with AIDS, six other (patients E and G) contacted the Centers patients of this dentist were found to be HIV-infected. Molecular biologic studies were for Disease Control (CDC) to report that conducted to complement the epidemiologic investigation. Portions of the HIV proviral they were HIV-infected. A former sex part- envelope gene from each of the seven patients, the dentist, and 35 HIV-infected persons nenamed by patient E was found to be from the local geographic area were amplified by polymerase chain reaction and se HIV-infected and had also been a patient of distance measure- the dentist (patient F). Characteristics of ments, phylogenetic tree analysis, and amino acid signature pattern analysis showed that these seven infected patients and the den- quenced. Three separate comparative genetkc the viruses from the dentist and five dental patients were closely related. These data, togetherwith the epidemiologic investigation, indicated that these patients became infected with HIV while receiving care from a dentist with AIDS. tist are included in Table 1 Patient D had previously been reported Y. Ou C. A. Ciosios, C. L Bandea, C-C. Luo, G Schochetman A. L Berkeiman, G. A Satten J. W Curan, and H. W Jafe are in Divition HNIAIDS Increasingly, molecular biologic tech high degree of genetic relatedness may im- National Centes ler Irlectious Dieases, Centers for Dipease Control, Atlanta, GA 30333 G. Myers, B. T. M niques have been used to study the epide- ply an epidemiologic linkage between per-Korber, and K A Macinnes are in the Theoretical Division, Los Alamos National Laboratory, Los lamos, NM 87545. J. L Mulins is in the Department of Microbiology and Immunology. Stanford University viral genetic sequence information, such as (HIV) has a high mutation rate (2, 3), such Sehol MSiSaartord, CA 94306. A N. Econ oligonucleotide fingerprinting of RNA ge- that HIVs from diferent individuals are found omou and J J Wete tho Florida Department of miology of infectious diseases. For viral sinfected with these strains. infections of humans, techniques to analyse The human vinus nomes with ribonuclease, mapping of DNA to be genetically distinct (3).In this article, and RohabiitaeSenvices Talahasse FL 32300 L J. Furman is in the Division ef Oral Hoalth, genomes with restriction endonucleases, we describe the use of genomic sequencing to National Cntr for Provention Services. Cantors for and genomic sequencing, have been used to investigate a cluster of HIV infections in a Disease Contro, Atlart, GA 30333 study viral transmissions from person to Florida dental practice. The high degree of J. Moore, Y. Villemarzo, and C. Schable, DMsin of person, within communities, and between genetic relatedness observed among the HIV HVIAOS and E. G. Shoser, Department of Microbioh countries (1). Requisite to such studies is strains from a dentist with acquired immuno ogy and mmunology, Stanford University School of the existence of viral genetic variation; the deficiency syndrome (AIDS) and five of his Uperti and s Lieb, Florida Department of Hoath greater the variation, the greater the power infected patients supports the epidemiologic andRehatilnative Services (HRS):R. Soon, J. Howell of the methods to distinguish strains of the investigation that indicated that these p variation, identification of strains with a ing dental care. Cumbeugn A Lsh FGa MRS Kroesen and L Ryan, Matin County Public Heath virus. For a virus with substantial genomic tients became infected with HIV while recevt, Foida HRS K. Bel, V. Munn, D. Mariancs, and B. Gooch, Centors for Disease Control SCIENCE VOL 256 ◆ 22 MAY 1992 1165

Answer 1

1) Along with dentist and patients A through G 35 local HIV seropositive people included in this study because of comparitive purpose. and they are local control specimen. 2) Patient D and F had known risk factors for contracting HIV and patientD has AIDS clinically. 3) Patient E was sex partner named by patient E was found to be HIV infected, and patient F is HIV infected and he pateient of the dentist.