title: Early antiretroviral treatment (eART) limits viral diversity over time in a long-term HIV viral suppressed perinatally infected child.
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.
  
  
  METHODS
  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.
authors.affiliation: Academic Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, P.zza Sant'Onofrio, 4-00165, Rome, Italy. paolo.palma@opbg.net.|Research Unit in Congenital and Perinatal Infections, Children's Hospital Bambino Gesù, Rome, Italy. paolo.palma@opbg.net.
authors.forename: Paolo
authors.initials: P
authors.lastname: Palma
authors.affiliation: Academic Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, P.zza Sant'Onofrio, 4-00165, Rome, Italy.|Research Unit in Congenital and Perinatal Infections, Children's Hospital Bambino Gesù, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Zangari
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Alteri
authors.affiliation: Academic Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, P.zza Sant'Onofrio, 4-00165, Rome, Italy.
authors.forename: Hyppolite K
authors.initials: HK
authors.lastname: Tchidjou
authors.affiliation: Academic Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, P.zza Sant'Onofrio, 4-00165, Rome, Italy.
authors.forename: Emma Concetta
authors.initials: EC
authors.lastname: Manno
authors.affiliation: Clinical Department, National Institute for Infectious Diseases 'L. Spallanzani', Rome, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Liuzzi
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Carlo Federico
authors.initials: CF
authors.lastname: Perno
authors.affiliation: Academic Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, P.zza Sant'Onofrio, 4-00165, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossi
authors.affiliation: Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Ada
authors.initials: A
authors.lastname: Bertoli
authors.affiliation: Academic Department of Pediatrics, Unit of Immune and Infectious Diseases, Children's Hospital Bambino Gesù, P.zza Sant'Onofrio, 4-00165, Rome, Italy. stefania.bernardi@opbg.net.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bernardi
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019259:Lamivudine / Q000627:therapeutic use; D061466:Lopinavir / Q000627:therapeutic use; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use; D010802:Phylogeny; D019438:Ritonavir / Q000627:therapeutic use; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D061466:Lopinavir; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; D019438:Ritonavir
keywords: Children; Early antiretroviral treatment; HIV; Immunotherapy; Viral evolution