Clinical implications of identifying non-B subtypes of human immunodeficiency virus type 1 infection.
Although human immunodeficiency virus type 1 (HIV-1) infection in the United States has predominantly involved subtype B, increasing global travel is leading to wider dissemination of genetically heterogeneous subtypes. While physicians depend on HIV-1 viral load measurements to guide antiretroviral therapy, commonly used molecular assays may underestimate the viral load of patients with non-B subtypes. Nine patients with non-B subtypes of HIV-1 were identified by physicians who suspected a non-B subtype on the basis of a low or undetectable HIV-1 viral load, by the Amplicor HIV-1 Monitor test, version 1.0, in conjunction with either a declining CD4 cell count or history of travel outside the United States. Use of version 1.5 of the Amplicor HIV-1 Monitor test detected a median HIV-1 viral load that was 2.0 log(10) RNA copies/mL higher than was determined with version 1.0. Clinical management was altered in all cases after diagnosis of a non-B-subtype infection. These cases demonstrate that it is critical for physicians to suspect and diagnose non-B subtypes of HIV-1 so that an assay with reliable subtype performance can be used to guide antiretroviral therapy.
Walter
E A
EA
Infectious Diseases Service, Department of Medicine, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX 78236-5300, USA. walter_beth@hotmail.com
Gilliam
B
B
Delmar
J A
JA
Spooner
K
K
Morris
J T
JT
Aronson
N
N
Wegner
S A
SA
Michael
N L
NL
Jagodzinski
L L
LL
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005500:Follow-Up Studies; D005838:Genotype; D015658:HIV Infections / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D015497:HIV-1 / Q000145:classification / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008297:Male; D008889:Military Personnel; D012367:RNA, Viral / Q000097:blood / Q000187:drug effects; D013997:Time Factors; D019562:Viral Load
D019380:Anti-HIV Agents; D012367:RNA, Viral