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Troublesome diagnosis in two children born to HIV-1 infected mothers
D Liberatore1, P Olivari, M Gómez Carrillo
1Department of Microbiology, University of Buenos Aires School of Medicine, Argentina.
Insights
Diagnosing early HIV infection in children can be challenging. This study presents two cases where initial positive HIV tests were later unconfirmed, suggesting possible viral clearance or sequestration.
Area of Science:
- Pediatrics
- Virology
- Immunology
Background:
- Early diagnosis of vertically transmitted HIV infection in children is crucial.
- Standard diagnostic methods may present challenges in interpretation.
- Rare cases of apparent HIV clearance have been reported.
Purpose of the Study:
- To report two cases of vertically transmitted HIV infection in children with complex diagnostic journeys.
- To highlight the difficulties in definitively diagnosing HIV in infants with initially positive but later indeterminate results.
Main Methods:
- Longitudinal follow-up of two infants born to HIV-1 infected mothers.
- Utilized viral culture, polymerase chain reaction (PCR), p24 antigen detection, and serologic techniques.
- Included Western Blot analysis for antibody confirmation.
Main Results:
- First child: PCR positive at 2, 8, and 30 months; indeterminate antibody tests until 34 months. No virus recovered, p24 antigen negative.
- Second child: PCR positive at 2 and 4 months; negative Western Blot from 25 months. No virus recovered, p24 antigen negative.
- Neither child had detectable virus or p24 antigen throughout the study period.
Conclusions:
- Potential explanations for the first case include viral sequestration in lymphatic tissue, low viral replicative capacity, or immunological tolerance.
- The second case suggests a possible clearance of HIV infection, if it occurred.
- These cases underscore the complexities in diagnosing and confirming early HIV infection in pediatric populations.
Abstract:
In order to assess early HIV infection vertically transmitted in children it is necessary to use techniques that directly detect HIV. Positive results were found in some rare cases who later seemed to have cleared the infection. We communicate two cases of children with troublesome diagnosis. Two girls born to HIV-1 infected mothers were followed-up since birth up to 40 months old, with viral culture, polymerase chain reaction (PCR), p24 antigen detection and serologic techniques. PCRs were positive in three opportunities at 2, 8 and 30 months of age in the first child and confirmatory tests for specific antibodies remained indeterminate up to the age of 34 months. Positive viral DNAs were detected in two opportunities in the second child at 2 and 4 months of age. Western Blots were negative since 25 months. No virus was recovered nor was p24 antigen detected during the whole period of study in either child. Sequestration of the virus in lymphatic tissue, low replicative ability of the virus and/or immunological tolerance can be postulated in the first case. In patient 2, it could be hypothesized that infection, if any, had cleared up.