Case Report: Homozygous CCR5 Delta-32 Protection Overcome by Infection With X4 Virus
A sobering and important report documented the case study of a man who was homozygous for the CCR5 delta-32 mutation that generally provides effective protection against infection from HIV.
With most circulating (and infectious) virus using the CCR5 co-receptor, individuals with this deletion in both chromosomes who are exposed to HIV provide a dead-end for the infection, with the virus unable to infection CD4 cells without the use of the coreceptor.
This case of a 39 year-old man -- who was diagnosed in 1996 -- was indentified by Ester Ballana and colleagues after retrospectively testing DNA from stored peripheral blood mononuclear cells (PBMCs). The man had started treatment within 6 months of diagnosis, at a CD4 count of 520 and viral load of 3,500 copies/mL. Sequence analysis of the env gene idicated homogeneous X4 virus.
Fifteen years after seroconversion, total HIV-1 proviral DNA was 60 copies/million PBMCs. CD4 count had only increased to 600-700 over this time but HLA haplotype analysis showed multiple alleles associated with slower HIC progression including HLA-B*5701 and HLA-A*2402.
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This article was provided by HIV i-Base. It is a part of the publication HIV Treatment Bulletin. Visit HIV i-Base's website to find out more about their activities, publications and services.
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