Clinical Pathology Selected Abstracts, 6/14

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Clinical pathology abstracts editor: Deborah Sesok-Pizzini, MD, MBA, associate professor, Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and medical director, Blood Bank and Transfusion Medicine, Children’s Hospital of Philadelphia.

How a single patient influenced HIV research: 15-year followup

The hope of a cure for human immunodeficiency virus infection is raised by recent reports of people in whom viral replication spontaneously reduced despite the absence of antiretroviral treatment (ART). A “Berlin patient” described in 1999 was immediately treated with ART and hydroxyurea after an acute HIV infection but chose to discontinue treatment. Due to his surprising level of natural control, it was proposed that early intervention might promote HIV-specific cytotoxic T-lymphocyte-mediated control by preserving CD4+ T helper cells. The authors reviewed followup of the patient, who chose to remain anonymous. The authors noted that viral load analysis showed that the patient had continual suppression of viral replication in the absence of any ART during the previous 15 years. During that period, the patient’s mean number of HIV RNA copies per milliliter was 2,812 ± 11,451, with one blip to 25,000 copies. Similarly, the patient’s CD4+ T-cell count remained stable. Of interest was a genotypic analysis that showed that the patient carried the highly protective HLA class I allele HLA-B*57. This allele is known to be associated with lower viral loads and is enriched in patients in whom HIV is spontaneously controlled in the absence of ART. In this patient, the most dominant cytotoxic T-lymphocyte-mediated response was directed against a known conserved epitope in Nef, suggesting a dominant role for this response in HIV control. The authors concluded that early initiation of treatment may have long-term benefits in certain patients, but the more likely explanation for control of the HIV infection is the patient’s genetic background. Therefore, the authors caution against drawing broad conclusions based on a single patient.

Jessen H, Allen TM, Streeck H. How a single patient influenced HIV research—15-year follow-up. N Engl J Med. 2014;370:682–683.

Correspondence: Hendrik Streeck at hstreeck@hivresearch.org