Management of pregnancy in an HIV elite controller.
Elite control of HIV infection has been defined as spontaneous and sustained maintenance of HIV RNA to <50 copies/mL in the absence of therapy. It is estimated to occur in approximately one in 300 HIV-infected individuals. We present the case of a Zimbabwean woman who tested positive for HIV-1 infection on routine antenatal bloods at 15 weeks gestation. Her CD4 count was 500 cells/mm(3); however, HIV-1 RNA viral load measured below the level of detection on several assays. A Cavidi ExaVir reverse transcriptase assay was below the level of detection. Pro-viral DNA was positive using long terminal repeat primers and sequencing demonstrated subtype C virus. Zidovudine monotherapy (250 mg twice daily) was commenced at 24 weeks for the prevention of mother to child transmission. She was keen for a standard vaginal delivery, having had one previously, and she delivered a healthy baby without complications at 39 weeks gestation. The neonate received four weeks of Zidovudine and tested negative for HIV infection. We discuss some challenges involved in the management of a pregnant 'elite controller'.
Rutland
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Portsmouth Hospitals NHS Trust, Portsmouth, UK. emma_rutland@hotmail.com
Mani
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D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D020276:HIV Long-Term Survivors; D015497:HIV-1 / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D011533:Proviruses / Q000235:genetics; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load; D015215:Zidovudine / Q000008:administration & dosage*; D015030:Zimbabwe
D019380:Anti-HIV Agents; D004279:DNA, Viral; D012367:RNA, Viral; D015215:Zidovudine