Abstract
Background:Reports of posttreatment control following antiretroviral therapy (ART) have prompted the question of how common immune control of HIV infection is in the absence of ART. In contrast to adult infection, where elite controllers have been very well characterized and constitute approximately 0.5% of infections, very few data exist to address this question in paediatric infection.Methods:We describe 11 ART-naive elite controllers from 10 cohorts of HIV-infected children being followed in South Africa, Brazil, Thailand, and Europe.Results:All but one of the elite controllers (91%) are females. The median age at which control of viraemia was achieved was 6.5 years. Five of these 11 (46%) children lost control of viraemia at a median age of 12.9 years. Children who maintained control of viraemia had significantly higher absolute CD4+ cell counts in the period of elite control than those who lost viraemic control. On the basis of data available from these cohorts, the prevalence of elite controllers in paediatric infection is estimated to be 5–10-fold lower than in adults.Conclusion:Although conclusions are limited by the study design, these data suggest that, whilst paediatric elite control can be achieved, compared with adult elite controllers, this occurs rarely, and takes some years after infection to achieve. Also, loss of immune control arises in a high proportion of children and often relatively rapidly. These findings are consistent with the more potent antiviral immune responses observed in adults and in females.
Highlights
The large majority of HIV-infected children rapidly develop AIDS in the absence of antiretroviral therapy (ART)(1)
We describe a larger number of ART-naïve HIV-infected children who achieved transient aviraemia (TA) on one or more occasions but who did not meet the elite controllers (EC) criteria
The TA group was defined as ART-naïve, vertically infected children in whom one or more HIV RNA measurements were below the limit of detection, but without fulfilling the EC criteria
Summary
The large majority of HIV-infected children rapidly develop AIDS in the absence of antiretroviral therapy (ART)(1). The features of paediatric non-progressors (PNP) are high viraemia in the presence of normal CD4+ T cell counts, reduced CCR5 expression in the central memory CD4 T-cell subset, low immune activation, and no correlation with protective major histocompatibility complex (MHC) class I molecules Many of these features are similar to those described in natural hosts of SIV infection such as the sooty mangabey[8, 9]. Adult non-progressors typically have normal CD4 counts but low or undetectable viral loads and most express the protective HLA alleles described above[12, 13]. Have prompted the question of how common immune control of HIV infection is in the absence of ART.
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