Review and feature articleAbsence of detectable viremia in a perinatally HIV-1–infected teenager after discontinuation of antiretroviral therapy
Section snippets
Case presentation
A 15-year-old African American girl presented to the Infectious Disease Clinic at Children's Hospital in Boston, Massachusetts, with asymptomatic vertically acquired HIV-1 infection. The patient was born to a mother with known HIV-1 infection who had received no antiretroviral prophylaxis in the perinatal period. The child's HIV-1 ELISA and Western Blot test results remained positive at 18 months of age, and she was therefore judged to be HIV-1 infected. At that time (in 1991), she began
Differential diagnosis
Although rare, spontaneous control of HIV viremia has been well described in the adult population.1 However, lack of detectable plasma viremia in the absence of therapy has not previously been reported in a perinatally HIV-1–infected child. Much of our current understanding of the factors that govern the rate of progression to AIDS has come through the study of adult long-term nonprogressors who maintain very low viral loads in the absence of therapy. Long-term nonprogressive HIV-1 infection
Laboratory testing
Viral, immunologic, and genetic factors were all considered potential contributors to the unusual clinical phenotype of our patient. Full-genome viral sequencing was performed with previously described PCR primers and conditions to rule out the possibility that the patient was infected with an attenuated strain of HIV-1.42 The virus was readily amplified from proviral DNA extracted from PBMCs at age 12.1 years, and no deletions or previously described fitness-attenuating polymorphisms were
Pathogenesis
Detailed laboratory analysis of this patient revealed a disease-attenuating genetic polymorphism, as well as an unusually robust HIV-specific CD4+ T-cell response, both of which could be contributing to the low level of viremia observed in this child. The patient was found to be heterozygous for a deletion in the CCR5 chemokine receptor gene, which encodes the principal cellular coreceptor for HIV-1 entry into cells. Heterozygosity for this CCR5Δ32 polymorphism leads to diminished cell-surface
Summary statement
This case serves as a reminder that the clinical course of HIV-1 disease is extremely heterogeneous, and multiple viral and host factors play a role in determining the rate of progression to AIDS. Although HIV infection remains, at present, an incurable illness, an increasing number of HIV-1–infected patients have been identified who remain asymptomatic well into the second or third decade of infection, including many patients who were infected perinatally. However, control of HIV viremia to
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Advances in basic and clinical immunology in 2006
2007, Journal of Allergy and Clinical ImmunologyCitation Excerpt :HIV research continues to make progress in the improvement of current therapies, particularly in the treatment of multidrug-resistant HIV strains and debilitating drug adverse effects. Feeney et al52 reported the first case of a patient with perinatally acquired HIV infection who was treated for 10 years with 3 different regimens of dual nucleoside reverse-transcriptase inhibitors and then self-discontinued therapy. After 5 years without treatment, the patient continued with normal CD4+ T cell counts and undetectable HIV plasma viremia.
Understanding the ingenuity of chemokines and their receptors
2006, Journal of Allergy and Clinical ImmunologyA SYSTEMATIC REVIEW ON THE INFLUENCE OF HLA-B POLYMORPHISMS ON HIV-1 MOTHER-TO-CHILD-TRANSMISSION
2019, Brazilian Journal of Infectious DiseasesCitation Excerpt :After detailed review, 83 were excluded: 30 reviews, 36 not related to MTCT, 17 had not enough information on HLA-B polymorphisms, or no sufficient data on HLA-B polymorphisms. In addition, four other studies were excluded for being case-reports,2 short communication,1 or letter to the editor.1,17–20 The remaining nine studies describing HLA-B polymorphisms in HIV-1 MTCT were included in this review.
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Supported by the National Institutes of Health (K23-AI52078, M.E.F.), the Elizabeth Glaser Pediatric AIDS Foundation (M.E.F.), and the Harvard Medical School Center for AIDS Research. M.E.F. is an Elizabeth Glaser Scientist of the Elizabeth Glaser Pediatric AIDS Foundation.
Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.