WOMAN GETS HIV FROM KISS.

Byline: Lawrence K. Altman The New York Times

A woman apparently acquired the AIDS virus from deep kisses with an infected man, federal health officials said Thursday. They said the case was the first reported transmission of HIV, the AIDS virus, through kissing.

Both the man and woman had gum disease, factors that apparently facilitated transmission of HIV. Transmission most likely was through the man's blood, not saliva, the Centers for Disease Control and Prevention in Atlanta said in its weekly report.

In emphasizing the rarity of such transmission, the federal centers said the case was the only known one involving kissing among the 500,000 AIDS cases that have been reported to it since the epidemic was detected in 1981.

The agency has long recommended against deeply kissing an infected individual and said individuals who did should be tested for HIV infection.

Those who do not know the infection status of the people they have kissed deeply may want to get HIV tests, just as they would ``for any number of better reasons, including unprotected sex with a member of a risk group,'' said Dr. Scott Holmberg, an AIDS expert at the centers.

But Holmberg said that the centers had not issued a recommendation about deep kisses with a partner of unknown HIV status. He and other experts emphasized that they considered the chances of such transmission remote.

Holmberg said the public health message that centers officials were trying to convey was that even when one sex partner was infected and the couples took recommended precautions, the risk of transmission through deep kissing, although very small, was not zero.

An unusual aspect of the case is the length of time the centers took to report it. The centers learned of the case in February 1996. The delay was attributed to several internal and external reviews.

The unusual transmission was detected in a study of couples in which only one of the two sexual partners was infected; it was conducted by Dr. Nancy Padian at the University of California, San Francisco.

The two partners enrolled in the study in 1992 when the man was known to be infected through the injection of drugs. The woman was uninfected. Both received extensive counseling, answered questionnaires and were tested periodically for HIV infection.

Biting has been reported to rarely cause HIV infection. Two years ago, doctors reported that a 91-year-old man became infected with HIV after a prostitute with bleeding gums bit his hand during a robbery in Florida.

The centers said there were several reasons exposure to saliva uncontaminated with blood rarely leads to transmission of HIV. Among them were these:

Substances in saliva tend to inhibit HIV.

HIV is isolated from saliva in low amounts, even in the presence of gum disease.

No case of AIDS reported to the centers has been attributed to exposure to saliva.

Transmission of HIV in association with kissing has not been documented in studies of nonsexual household contacts of HIV-infected individuals.

Health officials said they could not determine the exact way the virus was transmitted in the case of the man and woman and could not exclude oral sex, vaginal intercourse and other possibilities. But they concluded that deep kissing was the most likely possibility.

The identities of the man and woman were not disclosed in keeping with the standard practice of health investigations.

The woman told investigators she did not have any known risk exposures for HIV from June 1994, the month before an HIV test last showed she was not infected, to July 24, 1995, when a test first showed she was.

On Aug. 26, 1994, she developed a flu-like illness that lasted about a week. Such flu-like illnesses can be the first symptom of HIV infection. A test on Sept. 11, 1995, showed she was infected.

In their counseling, the couple was told about the recommendation against open-mouth to open-mouth kissing because the man was infected. The couple told medical investigators that they did engage in such kissing several times each month.

The man had refused therapy for HIV and one of his blood counts was at a low point at which the risk of transmitting HIV was increased. The man developed a complication of AIDS that affects the mouth. He said his gums often bled after he brushed and flossed his teeth and that the couple generally engaged in sexual intercourse and deep kissing at night after he brushed his teeth. Occasional instances of oral sex between the couple did not involve the exchanges of semen or blood, the couple told medical investigators.

The couple said the man always used latex condoms during vaginal intercourse. The condom tore once, but investigators believe this happened before the woman became infected. HIV transmission is rare when heterosexual couples use condoms consistently through vaginal intercourse.

Tests showed that the HIV from the man and woman were nearly the same genetically, supporting the conclusion that the woman acquired HIV from him.