CLEARANCE OF HIV-INFECTION IN 12 PERINATALLY INFECTED CHILDREN - CLINICAL, VIROLOGICAL AND IMMUNOLOGICAL DATA

Objective: A case of HIV infection clearance in a perinatally infected infant has been recently reported. We report here on the molecular, b iological and clinical features of such virus clearance in 12 children . Design and methods: We performed a retrospective analysis of the dia gnosis in our 6-year cohort of 188 children born to HIV-seropositive m others. HIV-1 was detected by coculture of infant peripheral blood mon onuclear cells (PBMC) with cord blood cells, direct culture of infant cells, and DNA polymerase chain reaction (PCR). The children were diag nosed three times during the first 3 months of life and then followed up over a postnatal period of 18-36 months. Results: The 12 reverted c hildren had at least two positive PCR in at least two amplified region s. Among them, six were tested positive in culture/coculture assay, an d five were treated long-term with zidovudine. Thus, seven out of 12 r eversions cannot be attributed to antiretroviral therapy. All the viro logical results became negative during the first year of life, and ser ology lowered to negative values between 9 and 23 months. We could not find any correlation between either neutralizing or antibody-dependen t cellular cytotoxicity-mediating antibodies and HIV clearance. Conclu sion: In our cohort, we showed that an unexpected number of children b orn to HIV-seropositive mothers (6.7%) cleared HIV infection during th e first year of life, and subsequently became seronegative. Interestin gly, most of these children exhibited unspecified clinical signs durin g the first months of life. Five of these children were tested positiv e only by PCR, which suggests a low virus load and could, at least par tly, explain spontaneous clearance. However, 4 years later, among the seven remaining infants, two seronegative children presented recurrent hepatosplenomegaly, which may indicate the presence of hidden virus n ot detectable by peripheral blood testing.