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However, the dynamic of the Nab response and resulting HIV-2 escape during acute infection and their impact in HIV-2 evolution and disease progression remain largely unknown. Our objective was to characterize the Nab response and the molecular and phenotypic evolution of HIV-2 in association with Nab escape in the first years of infection in two children infected at birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>CD4<jats:sup>+<\/jats:sup>T cells decreased from about 50% to below 30% in both children in the first five years of infection and the infecting R5 viruses were replaced by X4 viruses within the same period. With antiretroviral therapy, viral load in child 1 decreased to undetectable levels and CD4<jats:sup>+<\/jats:sup>T cells recovered to normal levels, which have been sustained at least until the age of 12. In contrast, viral load increased in child 2 and she progressed to AIDS and death at age 9. Beginning in the first year of life, child 1 raised high titers of antibodies that neutralized primary R5 isolates more effectively than X4 isolates, both autologous and heterologous. Child 2 raised a weak X4-specific Nab response that decreased sharply as disease progressed. Rate of evolution, nucleotide and amino acid diversity, and positive selection, were significantly higher in the envelope of child 1 compared to child 2. Rates of R5-to-X4 tropism switch, of V1 and V3 sequence diversification, and of convergence of V3 to a \u03b2-hairpin structure were related with rate of escape from the neutralizing antibodies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our data suggests that the molecular and phenotypic evolution of the human immunodeficiency virus type 2 envelope are related with the dynamics of the neutralizing antibody response providing further support for a model in which Nabs play an important role in HIV-2 pathogenesis.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1742-4690-10-110","type":"journal-article","created":{"date-parts":[[2013,10,24]],"date-time":"2013-10-24T15:17:13Z","timestamp":1382627833000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Evolution of the human immunodeficiency virus type 2 envelope in the first years of infection is associated with the dynamics of the neutralizing antibody response"],"prefix":"10.1186","volume":"10","author":[{"given":"Cheila","family":"Rocha","sequence":"first","affiliation":[]},{"given":"Rita","family":"Calado","sequence":"additional","affiliation":[]},{"given":"Pedro","family":"Borrego","sequence":"additional","affiliation":[]},{"given":"Jos\u00e9 Maria","family":"Marcelino","sequence":"additional","affiliation":[]},{"given":"In\u00eas","family":"B\u00e1rtolo","sequence":"additional","affiliation":[]},{"given":"Lino","family":"Rosado","sequence":"additional","affiliation":[]},{"given":"Patr\u00edcia","family":"Cavaco-Silva","sequence":"additional","affiliation":[]},{"given":"Perp\u00e9tua","family":"Gomes","sequence":"additional","affiliation":[]},{"given":"Carlos","family":"Fam\u00edlia","sequence":"additional","affiliation":[]},{"given":"Alexandre","family":"Quintas","sequence":"additional","affiliation":[]},{"given":"Helena","family":"Skar","sequence":"additional","affiliation":[]},{"given":"Thomas","family":"Leitner","sequence":"additional","affiliation":[]},{"given":"Helena","family":"Barroso","sequence":"additional","affiliation":[]},{"given":"Nuno","family":"Taveira","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2013,10,24]]},"reference":[{"key":"3609_CR1","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1016\/j.tim.2008.09.003","volume":"16","author":"TI De Silva","year":"2008","unstructured":"De Silva TI, Cotten M, Rowland-Jones SL: HIV-2: the forgotten AIDS virus. 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