Follow-Up of Vertically HIV-1–Infected Long-Surviving Children

Abstract

This study describes the clinical, immunologic, and virological characteristics of 30 vertically human immunodeficiency virus type 1 (HIV-1)-infected children older than 8 years of age (long-survivors) before the introduction of protease inhibitors therapy. All of them were followed from birth. At the age of 8 years, 7 children presented no HIV-1-associated signs or only mild ones and only 5 had severe clinical manifestations (acquired immune deficiency virus [AIDS]). The remaining 18 children presented moderate signs with some immunodeficiency. The follow-up from 8 years of age (3.5 years on the average) showed that 6 children remained asymptomatic and were therefore defined as long-survivors nonprogressors (average, 13 years) and only 4 children developed AIDS. Progressive encephalopathy was the most striking clinical manifestation at follow-up and occurred in 6 children (always after immunodeficiency) with a polymorphic picture combining eye movement alterations, pyramidal signs and symptoms and mental deterioration. The majority of our long-survivors carried a virus with nonsyncytia-inducing phenotype, thus confirming its association with long survival. A switch to syncytia-inducing phenotype was observed only in 2 cases during the follow-up, but their clinical status did not change at follow-up.

Oral lesions in HIV positive AIDS adolescents perinatally infected undergoing HAART

“…The progression of HIV infection is different in pediatric patients than in HIV+ adult patient. In spite of some confusion and overlapping definitions of different pediatric HIV+ populations, it seems that HIV+/AIDS children have a bimodal progression of the disease: fast progression and slow progression (3). HIV+/AIDS children that are fast progressors die before they are three years old, whereas slow progressor HIV+/AIDS children survive more than three years (3).…”

“…In spite of some confusion and overlapping definitions of different pediatric HIV+ populations, it seems that HIV+/AIDS children have a bimodal progression of the disease: fast progression and slow progression (3). HIV+/AIDS children that are fast progressors die before they are three years old, whereas slow progressor HIV+/AIDS children survive more than three years (3). Protease inhibitors of HIV-1 introduced in the antiretroviral therapy against HIV in the middle of 90's and their later combination with inhibitors of transcriptase reverse established the highly active antiretroviral treatment (HAART).…”

Predictors of immunologic long-term nonprogression in HIV-infected children: Implications for initiating therapy

“…Two retrospective studies of long-term survivors include descriptions of small subgroups of true nonprogressors. 7,8 Several additional studies have reported analyses of 1 or 2 virologic or host genetic variables in pediatric LTNPs. One report suggested that functional and structural alterations in HIV nef genes correlate with pediatric LTNPs.…”

Phylogenetic Demonstration of Two Cases of Perinatal Human Immunodeficiency Virus Type 2 Infection Diagnosed in Adulthood

“…1 However, the mother-to-child transmission rate of HIV-2 is reduced about 10-to 20-fold compared to HIV-1. 2,3 Vertical transmission of HIV-2 has been molecularly proved only once. 4 Compared to HIV-1, the epidemiology of HIV-2 is more difficult to study because most infections are diagnosed many years after infection has occurred.…”