Médecine néonatale et pédiatrique

Abstrait

Apparent Viral Clearance in HIV-Infected Children on Antiretroviral Therapy (ART) is Possible

Tafese Beyene Tufa and Abebe Sorsa

Background: Temporary clearance of HIV- antibodies (Ab) and -antigens (Ag) in the serum of HIV-infected children on effective antiretroviral therapy (ART)-regimens with excellent adherence are occurred occasionally. However, it is unlikely that ART alone can lead to HIV remission or cure due to rapid formation of persistent viral reservoirs follows acute HIV-1 infection.

Case Series: We report a case series of three young patients attending the ART-clinic of Asella Teaching Hospital (ATH), Arsi Zone, central Ethiopia, in which ART has been stopped due to the negativity of serum antibodies and antigen-essays. This turned out to be a mistake as all children experienced a rebound of viral load (VL) within a few months after stopping ART.

Discussion: In our patients, even with apparent clearance of the virus, HIV was not eradicated. This must remind treating physicians that clearance of serum HIV-antigens and antibodies in children on ART does not mean a cure of the HIV-infection and it frequently only represents a temporary status. If ART is stopped, the child should be continuously monitored, as a rebound of VL in the short term is highly probable. The combination antiretroviral therapy (cART) can reduce HIV viral loads to undetectable levels due to the host gains excellent immunity status. Because of some latently infected CD4+ T-cells represent a major reservoir of HIV that persists during cART, the infection can rapidly reemerge if the treatment is discontinued.

Conclusions: From these series case reports, we can conclude that there could be possibility of temporarily viral clearance and seronegative conversion in children on effective ART does not mean a ‘cure’ of the HIV-infection. If ART was stopped due to high suspicion of the “first positive result” following antibody and antigen negative test results after 18 months, the child should be strictly and continuously monitored. Rebound of plasm VL within short term is highly probable. In defaulter patient, viral re-supersession with reinitiating same ATR- regimen is possible.