title: Absence of detectable viremia in a perinatally HIV-1-infected teenager after discontinuation of antiretroviral therapy.
abstract: A 15-year-old girl with perinatal HIV-1 infection has remained asymptomatic with undetectable plasma HIV-1 viremia for more than 5 years after discontinuing all antiretroviral therapy. Viral sequence analysis of proviral HIV-1 DNA revealed no evident fitness-attenuating deletions or mutations. This subject exhibited an unusually robust HIV-specific T-cell response, with an intact CD4+ T cell-proliferative response to HIV-1 antigens. In addition, the subject was found to be heterozygous for the 32-bp deletion in the CCR5 gene, which encodes the primary coreceptor for HIV-1 entry into cells. This mutation mediates profound resistance to HIV infection in homozygotes and has been associated with delayed disease progression in heterozygotes after both horizontal and vertical HIV-1 infection. Although adults with long-term nonprogressive HIV disease have been studied at length, there is no prior description in the literature of a perinatally HIV-infected child whose plasma HIV-1 viremia is controlled to undetectable levels in the absence of antiretroviral therapy.
authors.affiliation: Partners AIDS Research Center and Infectious Disease Division, Massachusetts General Hospital, 149 13th Street, Charlestown, MA 02129, USA. mfeeney@partners.org
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Feeney
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Tang
authors.forename: Almas
authors.initials: A
authors.lastname: Rathod
authors.forename: Catherine
authors.initials: C
authors.lastname: Kneut
authors.forename: Kenneth
authors.initials: K
authors.lastname: McIntosh
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D018450:Disease Progression; D005260:Female; D015683:Gene Products, gag / Q000276:immunology; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology / Q000635:transmission / Q000821:virology*; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D011110:Polymorphism, Genetic; D019713:Receptors, CCR5 / Q000235:genetics; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology*
chemical_list: D019380:Anti-HIV Agents; D015683:Gene Products, gag; D019713:Receptors, CCR5