Absence of detectable HIV-1 viremia after treatment cessation in an infant

Abstract

An infant born to a woman with human immunodeficiency virus type 1 (HIV-1) infection began receiving antiretroviral therapy (ART) 30 hours after birth owing to high-risk exposure. ART was continued when detection of HIV-1 DNA and RNA on repeat testing met the standard diagnostic criteria for infection. After therapy was discontinued (when the child was 18 months of age), levels of plasma HIV-1 RNA, proviral DNA in peripheral-blood mononuclear cells, and HIV-1 antibodies, as assessed by means of clinical assays, remained undetectable in the child through 30 months of age. This case suggests that very early ART in infants may alter the establishment and long-term persistence of HIV-1 infection.

Figure 1. Detection of Human Immunodeficiency Virus Type 1 (HIV-1) Infection in the Child

Panel A shows HIV-1 RNA levels indicating confirmed HIV-1 infection, with positive values for HIV-1 RNA in plasma at four time points before and after the initiation of antiretroviral therapy (ART). The decline in the viral load was biphasic, which is typically seen during effective ART. Panel B shows HIV-1 RNA levels indicating sustained control of HIV-1 replication during ART and after the discontinuation of therapy. The solid arrow indicates the last time that prescriptions for ART were filled (at 15 months of age, according to pharmacy records), and the dashed arrow the time of the last administration of ART (at 18 months of age, according to maternal report). In both Panel A and Panel B, solid circles indicate detectable HIV-1 RNA, and open circles undetectable HIV-1 RNA; the shaded area indicates the limit of detection of the plasma viral-load assay. Panel C shows the percentage of CD4+ T cells from the child’s birth until 30 months of age. The shaded area indicates the CD4+ T-cell percentage in the normal range (10th to 90th percentiles); fluctuations in the normal range are due to age-related changes. 3TC denotes lamivudine, AZT zidovudine, and NVP nevirapine.