Pediatric HIV Long-Term Nonprogressors

Abstract

Patients infected with HIV are best categorized along a continuum from rapid progressors to HIV long-term nonprogressors. Long-term nonprogressors (LTNPs) are those in which AIDS develop many years after being infected with HIV, often beyond the 10-year mark, and represent 15–20% of the HIV infected patients. Many of these patients are able to control their infection and maintain undetectable viral loads for long periods of time without antiretroviral therapy. After a comprehensive literature search, we found extensive data related to HIV LTNPs in the adult population; however, very limited data was available related to LTNPs within the pediatric population. We present a case of pediatric HIV LTNPs, perinatally infected patient with undetectable viral loads, despite never receiving ART. Although there are not many instances of LTNPs among children, this child may be one, though she had intermittent viremia. She has continued to manifest serologic evidence of infection, with yearly ELISA and western blot positive tests. Based on the viral fitness studies that were performed, this case exemplifies an adolescent LTNP.

Comparison of HIV-1 nef and gag Variations and Host HLA Characteristics as Determinants of Disease Progression among HIV-1 Vertically Infected Kenyan Children

“…Compared to adults, children infected with HIV-1 generally progress to AIDS faster, with children in sub-Saharan Africa progressing faster than those in developed countries [ 3 , 4 ]. However, in some cases, children have remained asymptomatic through childhood into adolescence without treatment [ 5 , 6 ]. Several host and viral factors reportedly play roles in disease progression [ 1 , 7 , 8 ], but such findings remain inconclusive especially in the pediatric population.…”

A Nigerian adolescent with Long term Non-progressive HIV-infection: A case report

“…cohort studies in the USA and Europe approximated the prevalence to 5-8%. [20] Warszaski et al found 2% among studied French children, [16] but there is no data on the population of paediatric patients who are LTNPs in Nigeria. This should be researched.…”

Long-term non-progression and risk factors for disease progression among children living with HIV in Botswana and Uganda: A retrospective cohort study

“…In 2021, UNAIDS estimates indicated that 150,000 new HIV infections and 99,000 deaths occurred among African children [ 1 ]. Before the initiative of universal antiretroviral therapy (ART), it was widely noted that some children would remain AIDS-free for more than 10 years and could maintain normal-for-age clusters of differentiation (CD4 + ) T-cell counts [ 2 ] – so-called long-term nonprogressors (LTNP). Children capable of controlling HIV infection present the opportunity for unique insights into the natural host immune responses, which could be essential for the development of novel therapeutics and vaccines [ 3 ].…”

“…Unlike in adults, vertical HIV infection in pediatric cohorts provides a distinct advantage in estimating progression-free survival. The majority of infections occur (or are detectable) within 45 days of birth, with the remaining instances typically linked to breastfeeding or maternal seroconversion during breastfeeding [ 2 , 4 , 5 ]. Given the temporally fewer yet measurable childhood exposures [ 6 ], pediatric cohorts offer a valuable opportunity to accurately determine the proportion of LTNP.…”