Long-term stabilized immunological-virological parameters of HIV infection in an AIDS presenter followed for 20 years, with irregular or no antiretroviral therapy

We report the case of an HIV-infected patient who has been followed for 20 years, and despite presenting with AIDS (due to three episodes of cryptococcosis plus one of Pneumocystis jirovecii pneumonia) who during subsequent years missed, refused or took with limited compliance all recommended medications, including combination antiretroviral therapy, and primary and secondary antimicrobial chemoprophylaxis against opportunistic infections. The unexpected clinical and laboratory stabilization of our patient paralleled a progressive increase in his peripheral CD4+ T-lymphocyte count (range 410-825 cells/mL) and a relatively controlled HIV viraemia (5970-44,000 HIV-RNA copies/mL). Such a recovery of sufficient immune competency after experiencing four episodes of severe AIDS-associated opportunistic infections, without reliable antiretroviral and antimicrobial support raises several questions.