Long-term nonprogressive human immunodeficiency virus-1 infection in a kidney allograft recipient

We report a unique ease of a renal transplant patient with a long-term nonp rogressive human immunodeficiency virus type-1 (HIV-1) infection and who is asymptomatic despite sustained immunosuppression. Renal function is normal , and HIV infection was probably acquired through blood transfusion before the transplant, Nonprogression may be due either to an effective immune con trol of HIV replication or to particular genetic aspects of the virus. Seve ral virological investigations were carried out to verify if she is infecte d with an attenuated virus strain. Results show an unusual combination of h igh and stable CD4 count, ongoing viral replication and elevated viral load s. Attempts to isolate the virus from plasma were unsuccessful, but isolati on was possible from peripheral blood mononuclear cells, and the virus was shown to be non-syncytium-inducing. Sequence analysis of the nef gene revea led no mutation. This exceptional lack of progression of HIV infection unde r immunosuppressive therapy requires further investigation.