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Case Reports
. 2016 Dec 9;16(1):742.
doi: 10.1186/s12879-016-2092-z.

Early antiretroviral treatment (eART) limits viral diversity over time in a long-term HIV viral suppressed perinatally infected child

Paolo Palma  1   2 , Paola Zangari  3   4 , Claudia Alteri  5 , Hyppolite K Tchidjou  3 , Emma Concetta Manno  3 , Giuseppina Liuzzi  6 , Carlo Federico Perno  5 , Paolo Rossi  3 , Ada Bertoli  5 , Stefania Bernardi  7
Affiliations
Case Reports

Early antiretroviral treatment (eART) limits viral diversity over time in a long-term HIV viral suppressed perinatally infected child

Paolo Palma et al. BMC Infect Dis. .

Abstract

Background: HIV genetic diversity implicates major challenges for the control of viral infection by the immune system and for the identification of an effective immunotherapeutic strategy. With the present case report we underline as HIV evolution could be effectively halted by early antiretroviral treatment (eART). Few cases supported this evidence due to the difficulty of performing amplification and sequencing analysis in long-term viral suppressed patients. Here, we reported the case of limited HIV-1 viral evolution over time in a successful early treated child.

Case presentation: A perinatally HIV-1 infected infant was treated within 7 weeks of age with zidovudine, lamivudine, nevirapine and lopinavir/ritonavir. At antiretroviral treatment (ART) initiation HIV-1 viral load (VL) and CD4 percentage were >500,000 copies/ml and 35%, respectively. Plasma genotypic resistance test showed a wild-type virus. The child reached VL undetectability after 33 weeks of combination antiretroviral therapy (cART) since he maintained a stable VL <40copies/ml. After 116 weeks on ART we were able to perform amplification and sequencing assay on the plasma virus. At this time VL was <40 copies/ml and CD4 percentage was 40%. Again the genotypic resistance test revealed a wild-type virus. The phylogenetic analysis performed on the HIV-1 pol sequences of the mother and the child revealed that sequences clustered with C subtype reference strains and formed a monophyletic cluster distinct from the other C sequences included in the analysis (bootstrap value >90%). Any major evolutionary divergence was detected.

Conclusions: eART limits the viral evolution avoiding the emergence of new viral variants. This result may have important implications in host immune control and may sustain the challenge search of new personalized immunotherapeutic approaches to achieve a prolonged viral remission.

Keywords: Children; Early antiretroviral treatment; HIV; Immunotherapy; Viral evolution.

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Figures

Fig. 1
Fig. 1
Maximum likelihood phylogenetic tree constructed on the pol gene sequences of 102 isolates and additional 4 subtype C references. The tree was rooted using the midpoint rooting method. Branch lenghts were estimated with the best fitting nucleotide substitution model (GTR + G + I) according to a hierarchical likelihood ratio test. The bar at the bottom indicating 0.03 nucleotide substitution per site. The astericks (*) along a branch represent bootstrap support >85%. The 4 C sequences belonged to mother to child transmission chain are shown in red and the cluster involving them is in the gray box. The cartoon summarizes the timing of sampling
See this image and copyright information in PMC

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