Genetic determinants of pediatric HIV-1 infection: Vertical transmission and disease progression among children

It is very likely that perinatal human immunodeficiency virus type 1 (HIV-1 ) infection is influenced by a combination of virologic and host factors. A greater understanding of the role played by various risk factors for HIV-1 infection is crucial for the design of new preventive and therapeutic stra tegies. In recent years, a number of studies have suggested that host genet ic factors are important determinants of both the susceptibility to perinat al HIV-1 infection and the subsequent pathogenesis of acquired immunodefici ency syndrome (AIDS). Control of HIV-1 infection involves the processing of specific viral peptides and their presentation to cells of the immune syst em by highly polymorphic human leukocyte antigen (HLA) alleles. The contrib ution of multiple HLA class I and II alleles in modulating pediatric HIV/AI DS outcomes has now been confirmed by several independent groups. Penetrati on of HIV-1 into cells is mediated by interaction between CD4 and chemokine receptors that serve as entry coreceptors. Genetic polymorphisms in chemok ine ligand and chemokine receptor genes have recently been associated both with mother-to-child HIV-1 transmission and disease progression in children . These observations suggest a key role for genetic factors in pediatric HI V-1 infection. This article describes the current state of knowledge regard ing host genetic influences on pediatric HIV-1 infection and discusses the role of these genes in HIV/AIDS pathogenesis.