Virological response without CD4 recovery. A case of disappearing soldiers - Can basic science help?

The objective of antiretroviral therapy (ART) is to suppress viral replication so that immune restoration can occur. Failure of immune restoration is usually associated with poor virological suppression. In children a good immunological and clinical response to ART is often achieved despite incomplete viral suppression. However, we have recently managed a number of children in whom immune restoration did not occur despite excellent virological suppression. We present a case, discuss possible causes and speculate on the appropriate course of action.