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Follow-up of vertically HIV-1-infected long-surviving children
F Salvini1, G Scarlatti, A Bossi
1Department of Pediatrics "G. e D. De Marchi," University of Milan, Italy.
Insights
This study followed vertically infected children with human immunodeficiency virus type 1 (HIV-1) before protease inhibitors. Most long-term survivors maintained non-progressive disease, often linked to non-syncytia-inducing HIV-1 strains.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Immunology
Background:
- Vertical transmission of human immunodeficiency virus type 1 (HIV-1) can lead to long-term infection in children.
- Understanding the characteristics of HIV-1 long-term survivors is crucial for developing effective treatment strategies.
- The pre-protease inhibitor era provides a unique perspective on natural HIV-1 disease progression in children.
Purpose of the Study:
- To describe the clinical, immunologic, and virologic features of vertically HIV-1-infected children who survived beyond 8 years of age.
- To identify factors associated with long-term non-progression of HIV-1 disease in children.
- To analyze the impact of viral phenotype on disease progression in HIV-1-infected children.
Main Methods:
- Longitudinal follow-up of 30 vertically HIV-1-infected children from birth.
- Clinical assessment of HIV-1-associated signs and symptoms, including acquired immune deficiency syndrome (AIDS).
- Virologic characterization, focusing on viral phenotype (syncytia-inducing vs. non-syncytia-inducing).
Main Results:
- At 8 years, most children had mild or moderate HIV-1 manifestations; only 5 had AIDS.
- Over 3.5 years of follow-up, 6 children remained asymptomatic (long-term non-progressors, average age 13 years), and 4 developed AIDS.
- Progressive encephalopathy occurred in 6 children, typically after immunodeficiency, with varied neurological symptoms.
- The majority of long-term survivors harbored non-syncytia-inducing HIV-1 strains, suggesting a link to slower disease progression.
Conclusions:
- A significant proportion of vertically HIV-1-infected children can remain non-progressive for extended periods, even without early antiretroviral therapy.
- Non-syncytia-inducing viral phenotype is associated with better clinical outcomes and slower disease progression in pediatric HIV-1 infection.
- Encephalopathy is a notable clinical manifestation in progressing cases, highlighting the importance of neurological monitoring.
Abstract:
This study describes the clinical, immunologic, and virological characteristics of 30 vertically human immunodeficiency virus type 1 (HIV-1)-infected children older than 8 years of age (long-survivors) before the introduction of protease inhibitors therapy. All of them were followed from birth. At the age of 8 years, 7 children presented no HIV-1-associated signs or only mild ones and only 5 had severe clinical manifestations (acquired immune deficiency virus [AIDS]). The remaining 18 children presented moderate signs with some immunodeficiency. The follow-up from 8 years of age (3.5 years on the average) showed that 6 children remained asymptomatic and were therefore defined as long-survivors nonprogressors (average, 13 years) and only 4 children developed AIDS. Progressive encephalopathy was the most striking clinical manifestation at follow-up and occurred in 6 children (always after immunodeficiency) with a polymorphic picture combining eye movement alterations, pyramidal signs and symptoms and mental deterioration. The majority of our long-survivors carried a virus with nonsyncytia-inducing phenotype, thus confirming its association with long survival. A switch to syncytia-inducing phenotype was observed only in 2 cases during the follow-up, but their clinical status did not change at follow-up.