Bloodborne HIV: Don't Get Stuck!

Beginning in 1998, tests of sick children at Benghazi El-Fatih Hospital, Libya, found some to be HIV-positive with HIV-negative mothers. Through October 1998, testing found 48 HIV-positive children. In late 1998, a Libyan magazine, La Magazine (issue 78) reported the outbreak.[1]

To find other infected children, the government in late 1998 invited all children who had visited the hospital in the previous year to come for an HIV test. Tests of 4,745 children found 316 who were HIV-positive (these numbers come from an unpublished trip report by a WHO expert who visited Libya for three weeks from late December 1998 to early January 1999).

Eventually, further testing found more than 400 children infected during the outbreak from 1995-97 through 1999.[2] The government sent large contingents of HIV-positive children to hospitals in Italy and Geneva for further tests and treatment. In many respects, the Libyan government’s response to the outbreak set a good example: the government looked for all infected children, treated children, told the public about the outbreak, identified dangerous procedures, and stopped them.

In 2003, the Libyan government asked two European HIV experts (Vittorio Colizzi, and Luc Montagnier, the man who discovered HIV in 1983) to look at available evidence and to explain what happened. According to their report (quoted from pages 20-21)[3]: “The HIV nosocomial [hospital-acquired] infection of children which occurred at the Al-Fateh Hospital of Benghazi in 1997-1998-99 has presumably originated from the use of injection material contaminated by blood of one child infected through unidentified horizontal or vertical [mother-to-child](more probably) transmission… All [HIV] samples sequenced from these children (1997-1998-1999) belong to a similar viral subtype, strongly indicating a common origin… Alteration of the specific guidelines established to avoid nosocomial infections (not only for HIV but also for HCV), a large introduction of invasive procedures, the shortage of disposable materials leading to the re-use of injection material, are all possible reasons which may explain this massive nosocomial infection.”

At least 18 mothers of HIV-positive Libyan children were also HIV-positive, and had likely gotten HIV from their children through breastfeeding.[4] This is similar to other reports of children infecting mothers, presumably through breastfeeding, during hospital-based HIV outbreaks in Russia, Kazakhstan, Kyrgyzstan, and elsewhere.

Although the Libyan government did well by children, another part of the government’s response to the outbreak is reprehensible. The government charged that six foreigners (five Bulgarian nurses and a Palestinian doctor) working at the hospital deliberately infected the children. A court sentenced them to death for murder. Eventually, after negotiations that brought in France and Britain and other issues, Libya sent the six to Bulgaria in July 2007, ostensibly to serve life sentences for murder. The Bulgarian government immediately released them. This part of the story is told at length in Wikipedia,[1] and much of it is also documented in Injection! a full-length movie by Mickey Grant.[5]

References

1. Wikipedia. HIV trial in Libya. Available at: https://en.wikipedia.org/wiki/HIV_trial_in_Libya (accessed 13 October 2018).

2. de Oliveira D, Pybus OG, Rambaut A, et al. HIV-1 and HCV sequences from Libyan outbreak. Nature 2006; vol 444: pp 836-837. Available at: https://www.nature.com/articles/444836a.pdf (accessed 13 October 2018).

3. Montagnier L, Colizzi V. Final Report of Prof. Luc Montagnier and Prof. Vittorio Colizzi
to Libyan Arab Jamahiriya on the Nosocomial HIV infection at the Al-Fateh Hospital, Benghazi, Libya. Paris, 7 April 2003. Available at: http://www.webcitation.org/5Mempgl11 (accessed 13 October 2018).

4. Visco-comandini U, Longo B, Perinelli P. Possible child-to-mother HIV transmission by breastfeeding. JAMA 2005, 294: 2297-2302. Available at: https://jamanetwork.com/journals/jama/article-abstract/201833 (accessed 13 October 2018).

5. Grant M. Injection! 2005. Available at: https://www.youtube.com/watch?v=W00Kvn3T92g