Nature and evolution of the cellular HIV-1 reservoir in children and adolescents

Shortly after primary infection, HIV hides in cellular reservoirs from which it becomes difficult or almost impossible to dislodge. In the absence of effective antiretroviral therapy, there is almost invariably resurgence of productive infection leading to a decline in CD4+ T cell counts and progression of HIV disease. The course of HIV infection in adults (horizontal transmission) differs significantly from that acquired in children following perinatal transmission: steady-state viral load is higher in children, adherence issues make it more difficult to control viral load using antiretroviral therapy, and the life expectancy of HIV-infected children in absence of treatment is markedly shorter than that of adults. Compared to the situation in adults, we know very little about the nature of the cellular reservoir in children, about its importance at the quantitative level, about its persistence over time, about its evolution during infancy, childhood and adolescence, and about its influence on the pathogenesis of pediatric HIV-AIDS. Some reported cases of spontaneous remission of HIV infection in children in the absence of treatment have also fueled the hopes of discovering avenues leading to a functional cure for HIV-AIDS in both children and adults.