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Open Access Highly Accessed Case report

Possible transmission of human immunodeficiency virus-1 infection from an elite controller to a patient who progressed to acquired immunodeficiency syndrome: a case report

Michael Scott Killian1*, Girish N Vyas2, Rochak Mehta3, Karen Young3 and Osman Ebrahim4

Author Affiliations

1 Department of Medicine, University of California San Francisco, 513 Parnassus Avenue, Box 1270, San Francisco, CA, 94143, USA

2 Department of Laboratory Medicine, University of California San Francisco, 513 Parnassus Avenue, Box 0134, San Francisco, CA, 94143, USA

3 Roche Molecular Diagnostics, 4300 Hacienda Drive, Pleasanton, CA, 94588, USA

4 Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa

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Journal of Medical Case Reports 2012, 6:291  doi:10.1186/1752-1947-6-291

Published: 11 September 2012

Abstract

Introduction

Most individuals infected with human immunodeficiency virus-1, in the absence of antiretroviral therapy, exhibit persistent virus replication and declining CD4+ cell numbers, and progress to acquired immunodeficiency syndrome within 10 years of infection. Elite controllers are rare individuals with human immunodeficiency virus-1 infection who can maintain undetectable plasma virus levels and remain asymptomatic without antiretroviral therapy. It has been proposed that elite controllers benefit from being infected with attenuated human immunodeficiency virus-1 variants.

Case presentation

A 31-year-old African woman presented with human immunodeficiency virus-1 infection during pregnancy and was diagnosed with acquired immunodeficiency syndrome. Subsequently, her husband, a 31-year-old African man, was tested and found to be seropositive for human immunodeficiency virus-1. His plasma human immunodeficiency virus-1 ribonucleic acid level was found to be below the limit of detection of the clinical assay.

Conclusion

This report provides evidence for the first described case of human immunodeficiency virus-1 infection possibly transmitted from an elite controller to a patient who progressed to acquired immunodeficiency syndrome. This observation strengthens the case against avirulence as a mechanism that protects elite controllers.