Virological Remission in Two HIV-Infected Children After Early cART in Libreville, Gabon.

Abstract

Introduction: Early antiretroviral therapy has a positive impact on the follow-up of an HIV-positive child, allowing assessment of the child's clinical and biological course. We report two cases to highlight the effects of early triple antiretroviral therapy (cART) on viral remission with seroreversion of HIV-infected infants in Gabon. Case Presentation: We present two cases of infants born to HIV-infected mothers in Libreville (Gabon). The first infant was referred to the "Center Hospitalier Universitaire Mère-Enfant" (CHUME FJE) with a positive PCR result. He was born to a mother living with HIV, whose adherence to ART had been intermittent (7th and 9th months of pregnancy). Delivery was vaginal. At birth, nevirapine was administered discontinuously for 6 weeks. After a positive GenXpert PCR at 7 weeks, triple therapy was started with abacavir-lamivudine and ritonavir-boosted lopinavir (2IN-1IP). At 2 months, he was asymptomatic, and his clinical and laboratory parameters were normal. A second PCR at another Level 3 reference laboratory (CIRMF) confirmed HIV infection. We switched the antiprotease with an anti-integrase (dolutegravir, which was available). After 9 months of treatment, the patient's nutritional status was considered satisfactory, and the DNA PCR performed on GenXpert was negative. The second infant born to a mother living with HIV was admitted for posthospital monitoring of perinatal asphyxia. He was born by caesarean section, and nevirapine had been administered from birth. He was put on ART after two positive PCRs with zidovudine-lamivudine -nevirapine. At 4 months, the GenXpert DNA PCR became negative. Conclusion: Virological remission with seroreversion of a previously HIV-infected infant is possible in Gabon. Further immunological (Ac assay) and virological (ultrasensitive proviral DNA on blood mononuclear cells) tests are needed in this infant to determine his definitive status.