Phytohemagglutin-stimulated child and adult leukocytes equally supported CCR5-dependent (R5) and CXCR4-dependent (X4) HIV-1 replication. In contrast, when phytohemagglutin-stimulated leukocytes from either healthy or congenitally immunodeficient children were cultured on feeder cells, they well supported R5, but not X4 HIV-1 replication, whereas both viruses equally spread in adult cells maintained in similar conditions. Both child and adult cells showed similar levels of
IntroductionHIV type-1 (HIV-1) infects human beings of all ages and ethnicities. HIV-1 infects T lymphocytes and mononuclear phagocytes by engaging the primary receptor CD4 with its trimeric gp120 envelope (Env). Such an interaction leads to exposure of a second cryptic site of gp120 Env that becomes competent to bind to a chemokine coreceptor (CoR) molecule. Among other chemokine R, only CCR5 and CXCR4 are frequently used in vivo by HIV-1. Viruses using these CoRs are termed R5 and X4, respectively, 1 and CoR use varies with different clinical phases with R5 viruses dominating the early stages and with CXCR4 use being mostly confined to subtype B viruses, although described also in subtype A and E. 2 Furthermore, both in adults and children, infection starts as a monophyletic infection carried on by an R5 virus regardless of the viral phenotype predominant in the transmitter. 3,4 In the case of subtype B infection (dominant in the North America, Europe, and Australia), an extension of CoR use to CXCR4, or the presence of so-called "dual mix" viral phenotypes, occurs in approximately 50% of persons resulting in dual-tropic R5ϫ4 viruses; quite rarely, a true "switch" from R5 to X4 is observed. 5 CXCR4 usage, however, is frequently associated with an accelerated disease progression. 4 HIV-1 infection in children differs from that of adults by several parameters. First, although an acute mononucleosis-like illness is experienced in 50% to 70% of adults, 6 the clinical outcomes of primary HIV infection are not as evident in infants. 7 Second, quantification of plasma viremia during the first months of life frequently shows levels higher than those of acutely infected adults. 8 The following decline in plasma virus in perinatally infected infants usually takes place over years rather than months in the absence of combination antiretroviral therapy (cART), therefore resulting in a higher systemic viral exposure during the first months of life. 9 Third, although a clinically asymptomatic period follows primary HIV infection for many years in most adults (in the absence of cART), approximately 25% of infected children show a rapidly downhill course developing features characteristic of AIDS within the first year of life. 10,11 In addition, the mortality rate of children who develop features of AIDS early in life is substantially higher than for those who become symptomatic later during childhood. 12 However, as in adults, a minority of children do not show any signs or symptoms of AIDS by the age of 8 to 10 years. 10,13 A link between HIV disease prog...