Prognostic value of a CCR5 defective allele in pediatric HIV-1 infection

Background: A deletion of 32 base pairs in the CCR5 gene (Delta 32 CCR5) ha s been linked to resistance to HIV-1 infection in exposed adults and to the delay of disease progression in infected adults. Materials and Methods: To determine the role of Delta 32 CCR5 in disease pr ogression of HIV-1 infected children born to seropositive mothers, we studi ed a polymerase chain reaction in 301 HIV-1 infected, 262 HIV-1 exposed-uni nfected and 47 HIV-1 unexposed-uninfected children of Spanish and Italian o rigin. Infected children were further divided into two groups according to their rate of HIV-1 disease progression: rapid progressors who developed se vere clinical and/or immunological conditions within the second year of lif e, and delayed progressors with any other evolution of disease. Among the l atter were the long-term, non-progressors (LTNP) who presented with mild or no symptoms of HIV-1 infection above 8 years of age. Viral phenotype was s tudied for 45 delayed progressors. Results: No correlation was found between Delta 32 CCR5 and mother-to-child transmission of HIV-1. However, the frequency of the deletion was substant ially higher in LTNP, compared with delayed (p = 0.019) and rapid progresso rs (p = 0.0003). In children carrying the Delta 32 CCR5 mutation, the prese nce of MT-2 tropic virus isolate was associated with a severe immune suppre ssion (p = 0.028); whereas, the presence of MT-2 negative viruses correlate d with LTNP (p = 0.010). Conclusions: Given the rapidity and simplicity of the assay, the Delta 32 C CR5 mutation may be a useful predictive marker to identify children with de layed disease progression who, consequently, may not require immediate anti retroviral treatment.