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Evolution of HIV-1 in an HLA-B*57-positive patient during virologic escape.

Bailey JR, Zhang H, Wegweiser BW, Yang HC, Herrera L, Ahonkhai A, Williams TM, Siliciano RF, Blankson JN

Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.

Elite suppressors maintain normal CD4(+) T cell counts and viral loads of <50 copies of human immunodeficiency virus type 1 (HIV-1) RNA per milliliter of plasma without antiviral therapy. We report here a case of virologic escape in a human leukocyte antigen (HLA)-B*57-positive patient shortly after seroconversion. This escape was associated with the development of mutations in 2 HLA-B*57-restricted CD8(+) T cell Gag epitopes, reversion of the drug-resistance mutation M184V, and reversion of a novel polymorphism in Vpu. The present study suggests that control of viral replication in elite suppressors may be due to HIV-1-specific CD8(+) T cells and, in some cases, mutations that have subtle effects on viral fitness.

Published 31 May 2007 in J Infect Dis, 196(1): 50-5.
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