Follow-up of vertically HIV-1-infected long-surviving children

This study describes the clinical, immunologic, and virological characteris tics of 30 vertically human immunodeficiency virus type 1 (HIV-1)-infected children older than 8 years of age (long-survivors) before the introduction of protease inhibitors therapy. All of them were followed from birth. At t he age of 8 years, 7 children presented no HIV-1-associated signs or only m ild ones and only 5 had severe clinical manifestations (acquired immune def iciency virus [AIDS]). The remaining 18 children presented moderate signs w ith some immunodeficiency. The follow-up from 8 years of age (3.5 years on the average) showed that 6 children remained asymptomatic and were therefor e defined as long-survivors nonprogressors (average, 13 years) and only 4 c hildren developed AIDS. Progressive encephalopathy was the most striking cl inical manifestation at follow-up and occurred in 6 children (always after immunodeficiency) with a polymorphic picture combining eye movement alterat ions, pyramidal signs and symptoms and mental deterioration. The majority o f our long-survivors carried a virus with nonsyncytia-inducing phenotype, t hus confirming its association with long survival. A switch to syncytia-ind ucing phenotype was observed only in 2 cases during the follow-up, but thei r clinical status did not change at follow-up.