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Introduction  Human  APOBEC3G  is a host defense factor that potently inhibits HIV replication. We hypothesize that HIV-infected children with a genetic variant of  APOBEC3G  will have a more rapid disease progression.    Methods  Antiretroviral therapy (ART)-naïve children, aged 1–12 years old with CD4 15-24% and without severe HIV-related symptoms were enrolled. The children had CD4% and absolute CD4 counts every 12 weeks and HIV-RNA every 24 weeks until 144 weeks. ART was started when CD4% declined to < 15% or AIDS-related events developed.   APOBEC3G  genetic variants were performed by PCR-based restriction fragment length polymorphism techniques from peripheral blood mononuclear cells. Random-effect linear regression analysis was performed to correlate APOBEC3G genotypes and disease progression.    Results  147 children, 35% male, with a median (IQR) age of 6.5 (4.3-8.8) years were enrolled. CDC N:A:B were 1:63:36%. Median baseline values were 20% for CD4% 605 cells/mm 3  for CD4 count and 4.7 log 10 copies/mL for HIV-RNA.  The frequencies of  APOBEC3G  genotypes AA (186H/H), AG (186H/R), GG (186R/R) were 86%, 12%, and 2% respectively. The  APOBEC3G  genotype GG was associated with a significant decline in CD4% -5.1% (−8.9 to −1.2%), p<0.001, and CD4 counts −226 (−415 to −34) cells/mm 3 , p<0.001 by random-effect liner regression analysis. No significant associations of  APOBEC3G  genotypes with HIV-RNA changes overtime (p=0.16) or progression to CDC B and C (p=0.49) were observed.    Conclusions   APOBEC3G  genotype GG was significantly associated with a more rapid decline in CD4.  APOBEC3G ’s antiviral effects on HIV disease progression in children should be further explored.

Association of APOBEC3G genotypes and CD4 decline in Thai and Cambodian HIV-infected children with moderate immune deficiency