{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:58:15Z","timestamp":1791496695370,"version":"4.3.4"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,8,1]]},"abstract":"<jats:p>OBJECTIVES: Although some caregivers are known to premasticate food for infants, usually during the weaning period, HIV transmission has not been linked to this practice. We describe 3 cases of HIV transmission in the United States possibly related to this practice.<\/jats:p><jats:p>PATIENTS AND METHODS: Three cases of HIV infection were diagnosed in children at ages 9, 15, and 39 months; clinical symptomatology prompted the testing. A thorough investigation to rule out alternative modes of transmission was conducted. In addition, phylogenetic comparisons of virus from cases and suspected sources were performed by using the C2V3C3 or gp41 region of env and the p17 coding region of gag.<\/jats:p><jats:p>RESULTS: In 2 cases, the mothers were known to be infected with HIV, had not breastfed their children, and perinatal transmission of HIV had previously been ruled out following US HIV testing guidelines. In the third case, a great aunt who helped care for the child was infected with HIV, but the child's mother was not. All 3 children were fed food on multiple occasions that had been premasticated by a care provider infected with HIV; in 2 cases concurrent oral bleeding in the premasticating adult was described. Phylogenetic analyses supported the epidemiologic conclusion that the children were infected through exposure to premasticated food from a caregiver infected with HIV in 2 of the 3 cases.<\/jats:p><jats:p>CONCLUSIONS: The reported cases provide compelling evidence linking premastication to HIV infection, a route of transmission not previously reported that has important global implications including being a possible explanation for some of the reported cases of \u201clate\u201d HIV transmission in infants, so far attributed to breastfeeding. Until the risk of premastication and modifying factors (eg, periodontal disease) are better understood, we recommend that health care providers routinely query children's caregivers and expecting parents who are infected with HIV or at risk of HIV infection about this feeding practice and direct them to safer, locally available, feeding options.<\/jats:p>","DOI":"10.1542\/peds.2008-3614","type":"journal-article","created":{"date-parts":[[2009,7,21]],"date-time":"2009-07-21T00:34:48Z","timestamp":1248136488000},"page":"658-666","source":"Crossref","is-referenced-by-count":68,"title":["Practice of Feeding Premasticated Food to Infants: A Potential Risk Factor for HIV Transmission"],"prefix":"10.1542","volume":"124","author":[{"given":"Aditya H.","family":"Gaur","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee; Divisions of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth L.","family":"Dominguez","sequence":"additional","affiliation":[{"name":"HIV\/AIDS Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia L.","family":"Kalish","sequence":"additional","affiliation":[{"name":"AIDS, STD, and TB Laboratory Research, National Center for HIV\/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delia","family":"Rivera-Hernandez","sequence":"additional","affiliation":[{"name":"Miller School of Medicine, University of Miami, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Donohoe","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee; Divisions of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Brooks","sequence":"additional","affiliation":[{"name":"HIV\/AIDS Prevention"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles D.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Miller School of Medicine, University of Miami, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2009,8,1]]},"reference":[{"key":"2021120905294391200_R1","doi-asserted-by":"crossref","unstructured":"D'Ippolito M, Read JS, Korelitz J, Joao EC, Mussi-Pinhata M, Rocha N. Missed opportunities for prevention of mother-to-child transmission of human immunodeficiency virus type 1 in Latin America and the Caribbean: the NISDI Perinatal Study. Pediatr Infect Dis J.\u20082007;26(7):649\u2013653","DOI":"10.1097\/INF.0b013e3180618bd6"},{"key":"2021120905294391200_R2","doi-asserted-by":"crossref","unstructured":"McDonald C, Lambert J, Nayagam D, et al. Why are children still being infected with HIV? Experiences in the prevention of mother-to-child transmission of HIV in south London. Sex Transm Infect.\u20082007;83(1):59\u201363","DOI":"10.1136\/sti.2006.021535"},{"key":"2021120905294391200_R3","doi-asserted-by":"crossref","unstructured":"Hennart P, Vis HL. Breast-feeding and post partum amenorrhoea in Central Africa. 1. Milk production in rural areas. J Trop Pediatr.\u20081980;26(5):177\u2013183","DOI":"10.1093\/tropej\/26.5.177"},{"key":"2021120905294391200_R4","doi-asserted-by":"crossref","unstructured":"Imong SM, Jackson DA, Rungruengthanakit K, et al. Maternal behaviour and socioeconomic influences on the bacterial content of infant weaning foods in rural northern Thailand. J Trop Pediatr.\u20081995;41(4):234\u2013240","DOI":"10.1093\/tropej\/41.4.234"},{"key":"2021120905294391200_R5","unstructured":"Neander WL, Morse JM. Tradition and change in the Northern Alberta Woodlands Cree: implications for infant feeding practices. Can J Public Health.\u20081989;80(3):190\u2013194"},{"key":"2021120905294391200_R6","doi-asserted-by":"crossref","unstructured":"Radbill SX. Infant feeding through the ages. Clin Pediatr (Phila).\u20081981;20(10):613\u2013621","DOI":"10.1177\/000992288102001001"},{"key":"2021120905294391200_R7","doi-asserted-by":"crossref","unstructured":"Walburn JN, Pergam JM, Perry SH, Jensen J. Black child care practices in the Midwest. Pediatrics.\u20081988;82(5):789\u2013790","DOI":"10.1542\/peds.82.5.789"},{"key":"2021120905294391200_R8","unstructured":"Lewis CW, Riedy CA, Grossman DC, Domoto PK, Roberts MC. Oral health of young Alaska Native children and their caregivers in Southwestern Alaska. Alaska Med.\u20082002;44(4):83\u201387"},{"key":"2021120905294391200_R9","doi-asserted-by":"crossref","unstructured":"Robbins KE, Weidle PJ, Brown TM, et al. Molecular analysis in support of an investigation of a cluster of HIV-1-infected women. AIDS Res Hum Retroviruses.\u20082002;18(15):1157\u20131161","DOI":"10.1089\/088922202320567914"},{"key":"2021120905294391200_R10","unstructured":"Rambaut A. Se-Al: Sequence Alignment Editor [computer program]. Version 1.0. Oxford, United Kingdom: distributed by the author; 1996"},{"key":"2021120905294391200_R11","doi-asserted-by":"crossref","unstructured":"Posada D, Crandall KA. Modeltest: testing the model of DNA substitution. Bioinformatics.\u20081998;14(9):817\u2013818","DOI":"10.1093\/bioinformatics\/14.9.817"},{"key":"2021120905294391200_R12","unstructured":"PAUP*, Phylogenetic Analysis Using Parsimony [computer program]. Version 4.0b8. Sunderland, MA: Sinauer Associates, Inc; 2001"},{"key":"2021120905294391200_R13","doi-asserted-by":"crossref","unstructured":"Moutsopoulos NM, Nares S, Nikitakis N, et al. Tonsil epithelial factors may influence oropharyngeal human immunodeficiency virus transmission. Am J Pathol.\u20082007;171(2):571\u2013579","DOI":"10.2353\/ajpath.2007.061006"},{"key":"2021120905294391200_R14","doi-asserted-by":"crossref","unstructured":"Imong SM, Rungruengthanakit K, Ruangyuttikarn C, Wongsawasdii L, Jackson DA, Drewett RF. The bacterial content of infant weaning foods and water in rural northern Thailand. J Trop Pediatr.\u20081989;35(1):14\u201318","DOI":"10.1093\/tropej\/35.1.14"},{"key":"2021120905294391200_R15","unstructured":"Huang MJ. An epidemiological study on prevalence and risk factors of hepatitis B virus (HBV) infection in preschool children [in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi.\u20081990;11(3):129\u2013132"},{"key":"2021120905294391200_R16","unstructured":"Zhang Y. The Role of Premastication in the Evolution of Complementary Feeding Strategies: A Bio-Cultural Analysis [honors thesis]. Ithaca, NY: Cornell University; 2007. Available at: http:\/\/ecommons.library.cornell.edu\/bitstream\/1813\/7810\/1\/Zhang,%20Yuanyuan.pdf. Accessed January 30, 2009"},{"key":"2021120905294391200_R17","doi-asserted-by":"crossref","unstructured":"Fein SB, Grummer-Strawn LM, Raju TN. Infant feeding and care practices in the United States: results from the Infant Feeding Practices Study II. Pediatrics.\u20082008;122(suppl 2):S25\u2013S27","DOI":"10.1542\/peds.2008-1315b"},{"key":"2021120905294391200_R18","doi-asserted-by":"crossref","unstructured":"Steinkuller JS, Chan K, Rinehouse SE. Prechewing of food by adults and streptococcal pharyngitis in infants. J Pediatr.\u20081992;120(4 pt 1):563\u2013564","DOI":"10.1016\/S0022-3476(05)82483-7"},{"key":"2021120905294391200_R19","unstructured":"Centers for Disease Control and Prevention. 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Pediatr Dent.\u20082007;29(1):16\u201322"},{"key":"2021120905294391200_R23","doi-asserted-by":"crossref","unstructured":"Mbulaiteye SM, Pfeiffer RM, Whitby D, Brubaker GR, Shao J, Biggar RJ. Human herpesvirus 8 infection within families in rural Tanzania. J Infect Dis.\u20082003;187(11):1780\u20131785","DOI":"10.1086\/374973"},{"key":"2021120905294391200_R24","doi-asserted-by":"crossref","unstructured":"Mbulaiteye SM, Walters M, Engels EA, et al. High levels of Epstein-Barr virus DNA in saliva and peripheral blood from Ugandan mother-child pairs. J Infect Dis.\u20082006;193(3):422\u2013426","DOI":"10.1086\/499277"},{"key":"2021120905294391200_R25","unstructured":"Callahan CM, Vincent AL, Greene JN, Sandin RL. Infections in oncology: infectious causes of malignancy. Cancer Control [serial online]. 1999;6(3). Available at: www.moffitt.org\/site.aspx?spid=70F1A2340DC748F6ACE061475B65B9F6. 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