Long-term symptomless HIV-1 infection in recipients of blood products from a single donor.
There have been reported cases of long-term symptomless human immunodeficiency virus type 1 (HIV-1) infection, but it is not clear whether the benign course of infection was due to host, viral, or other unknown factors. During follow-up of subjects with transfusion-acquired HIV-1 infection in New South Wales, Australia, we identified a group of 6 subjects who had been infected through a single common donor. We were therefore able to study the contributions of various factors to the course of infection. Throughout follow-up (range 6.8-10.1 years after infection), 5 of the recipients and the donor (last follow-up 10.2 years after infection of the first recipient) remained clinically free of symptoms, with normal CD4 cell counts and no p24 antigenaemia. HIV-1 was isolated from only 1 recipient; the isolate did not induce syncytia in a SUPT1 co-culture assay and had a limited in-vitro host range. 1 infected recipient (who had received extensive immunosuppressive treatment for systemic lupus erythematosus) developed Pneumocystis carinii pneumonia and died 4.3 years after infection. The frequency of progression to AIDS or a CD4 cell count below 0.50 x 10(9)/l was significantly lower among the 6 subjects with a common donor (1/6) than among 101 other HIV-infected transfusion recipients for whom data from 7 years of follow-up were available (94/101; p less than 0.0001). These findings suggest that the subjects were infected by a less virulent strain of HIV-1. The identification of this group of subjects should stimulate a search for other similar groups, which will provide important information on the immunopathogenesis of HIV-1 disease.
New South Wales Red Cross Blood Transfusion Service, Sydney, Australia.
J
J
Learmont
B
B
Tindall
L
L
Evans
A
A
Cunningham
P
P
Cunningham
J
J
Wells
R
R
Penny
J
J
Kaldor
D A
DA
Cooper
D000163:Acquired Immunodeficiency Syndrome / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001782:Blood Donors; D016516:CD4-CD8 Ratio; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism / Q000382:microbiology; D005260:Female; D016655:HIV Core Protein p24 / Q000378:metabolism; D015658:HIV Infections / Q000382:microbiology; D006679:HIV Seropositivity / Q000382:microbiology*; D015497:HIV-1 / Q000302:isolation & purification* / Q000472:pathogenicity; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D050378:T-Lymphocytes, Regulatory / Q000378:metabolism / Q000382:microbiology; D065227:Transfusion Reaction; D014774:Virulence; D001613:beta 2-Microglobulin / Q000378:metabolism
D016655:HIV Core Protein p24; D001613:beta 2-Microglobulin