Slow progression of paediatric HIV disease: Selective adaptation or a chance phenomenon?

Abstract

Background: Disease progression in human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) is affected by several factors both external and internal to the human hosts. In the European Caucasian populations, the chemokine-cell receptor variant CCR5 \"Delta 32\" is a the genetic determinant of HIV disease progression that is believed to have been selected for in the general population by exposure to antigens closely interlinked to HIV like Yersinia pestis or small pox virus. Among African populations, it is possible that this selection will be induced by HIV over time.
Aim: To present two cases of mother-to-child transmitted HIV highlighting the possible increasing prevalence of slow disease progression.
Methods: Clinical case reports of slow progression of pediatric HIV
Results: Both patients were female, had lost one parent >10yrs earlier but had the other surviving parent exhibiting slow HIV disease progression. We question the possible inheritance of the genetic factors associated with slow disease progression in a recessive X-linked Mendellian pattern and the role of the high prevalence of HIV within the sub-Saharan setting as the selective pressure favoring the establishment of the currently known immunologic and genetic factors influencing HIV diseases progression.
Conclusion: A more in-depth immunologic and genetic approach is called for to further examine the baseline prevalence and possibility of adaptive selection for immunogenetic protectors of HIV disease progression within the sub-Saharan setting.


Keywords: Paediatric HIV, Slow progression, Selective adaptation, Chance phenomenon

Port Harcourt Medical Journal Vol. 2 (1) 2007: pp. 83-87