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Viral rebound: case report A 15-year-old boy had viral rebound following discontinuation of antiretroviral treatment with lamivudine, nevirapine and zidovudine for HIV infection in Botswana. The boy was diagnosed with perinatal HIV infection within one month of life. His mother had been diagnosed with HIV infection and was treated with prophylaxis treatment for the prevention of mother-to-child transmission. At birth, HIV DNA PCR was negative. On one month and 2 months of age, HIV DNA PCR showed positive results. The positive HIV results indicated that, HIV transmission occurred either by intrapartum or early breastfeeding. Therefore, at the age of 9 months, he started receiving antiretroviral therapy with lamivudine, nevirapine and zidovudine [routes and dosages not stated]. The antiretroviral treatment was continued untill the age of 14 years with consistent viral suppression. At 14 years 4 months of age, the rapid HIV test showed negative results with undetectable viral load. Additional tests also confirmed negative results. Hence, at the age of 14 years 11 months, the boy’s antiretroviral treatment was stopped. At the current presentation (at the age of 15 years 8 months), he was recruited to a new reservoir study in 2018. Nine months after discontinuation of antiretroviral treatment, his viral load was 186,762 HIV RNA copies/mL. Enzymes-linked immunosuppression assay showed positive results for HIV, which indicated viral rebound after the termination of antiretroviral treatment [outcome not stated]. Author comment: "The case described is the first report in Botswana in which termination of [lamivudine/nevirapine/ zidovudine] following negative HIV tests during longterm [lamivudine/nevirapine/zidovudine] led to viral rebound." Koofhethile CK, et al. Undetectable proviral deoxyribonucleic acid in an adolescent perinatally infected with human immunodeficiency virus-1C and on long-term antiretroviral therapy resulted in viral rebound following antiretroviral therapy termination: A case report with implications for clinical care. Medicine 98: No. 47, Nov 2019. Available from: URL: http://doi.org/10.1097/ 803442884 MD.0000000000018014 - Botswana

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Reactions 4 Jan 2020 No. 1785