title: Host factors and early treatments to restrict paediatric HIV infection and early disease progression.
abstract: A body of evidence indicates that a threshold level of the virus is required to establish systemic and persistent HIV infection in the host and that this level depends on virus-host interactions. Mother-to-child transmission (MTCT) of HIV is the main source of paediatric HIV infection and occurs when the host's immune system is still developing. Thus, innate resistance and immunity, rather than adaptive immune response, may be the main drivers in restricting the establishment of HIV reservoirs and the long-lived persistence of HIV infection in infants. Genetic variations in HIV co-receptors and their ligands, as well as in Toll-like receptors and defensins, key elements of innate immunity, have been demonstrated to influence the risk of perinatal HIV infection and disease progression in HIV-infected infants. Early treatments with combined antiretroviral therapy (cART) restrict paediatric infection by reducing the level of the transmitted/infecting virus to below the threshold required for the onset of immune response to the virus and also significantly reduce HIV reservoirs. However, despite long periods with no signs and symptoms of HIV infection, all early cART-treated children who later discontinued cART had a rebound of HIV, except for one case in whom a period of viral remission occurred. Which parameters predict viral remission or viral rebound after cART discontinuation? Could early cART prevent rather than just reduce the establishment of viral reservoirs? And, if so, how? Answers to these questions are also important in order to optimise the use of early cART in infants at high risk of HIV infection.
authors.affiliation: Section of Oncology and Immunology, AIDS Reference Center, Department of Oncology and Immunology , University of Padua , Italy.
authors.forename: Ketty
authors.initials: K
authors.lastname: Gianesin
authors.affiliation: Section of Oncology and Immunology, AIDS Reference Center, Department of Oncology and Immunology, University of Padua, Italy; Centro di Riferimento Oncologico (CRO)-IRCCS, Aviano, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Petrara
authors.affiliation: Section of Oncology and Immunology, AIDS Reference Center, Department of Oncology and Immunology, University of Padua, Italy; Penta Foundation, Padua, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Freguja
authors.affiliation: Istituto Oncologico Veneto (IOV)-IRCCS , Padua , Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: Zanchetta
authors.affiliation: Penta Foundation, Padua, Italy; Department of Mother and Child Health, University of Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Giaquinto
authors.affiliation: Section of Oncology and Immunology, AIDS Reference Center, Department of Oncology and Immunology, University of Padua, Italy; Istituto Oncologico Veneto (IOV)-IRCCS, Padua, Italy.
authors.forename: Anita
authors.initials: A
authors.lastname: De Rossi
keywords: HIV reservoir; early cART; innate immunity; perinatal HIV infection; prevention of chronic HIV infection