title: Persistence of multidrug-resistant HIV-1 without antiretroviral treatment 2 years after sexual transmission.
abstract: OBJECTIVE
  To understand the virological mechanisms of 2-year persistence of multidrug-resistant virus without selective antiretroviral pressure in HIV-1-infected patients.
  
  
  METHODS
  Two patients were contaminated recently by their HIV-1-infected partners, who had received, before the transmission, all available antiretroviral drugs and who exhibited a severe therapeutic failure. The resistance mutations analysis was performed by clonal sequencing of 1.2 kb of pol gene in plasma of index and sources patients. Sequencing of HIV-1 DNA was performed in PBMCs of index patients.
  
  
  RESULTS
  Genotypic testing performed in index patients at time of seroconversion showed resistance mutations to three classes of drugs. All mutations were linked on the same viral genome and all quasispecies carried all mutations. No wild-type virus was detected. The same results were found in source patients and showed that all mutations were transmitted. In the index patients, all mutations persisted over 2 years without antiretroviral treatment. Moreover, the resistance mutations were all archived in the cellular reservoir. Viral load and CD4 count of index patients remained unchanged during 2 years of follow-up.
  
  
  CONCLUSIONS
  Only multidrug-resistant viruses were detected in the source patients and could be transmitted in index patients. In the latter, an expansion of predominant multidrug-resistant quasispecies and the 'archival' of all mutations were observed. These results explain the persistence of mutations and suggest that it is highly difficult to return to a wild-type viral population, sensitive to an antiretroviral treatment. The treatment of index patients is limited and the major risk is the transmission of these multidrug-resistant viruses. This work was presented in part in the XII International HIV Drug Resistance Workshop, Los Cabos, Mexico, June 2003; and in the 2nd IAS Conference on HIV Pathogenesis & Treatment, Paris, France, July 2003.
authors.affiliation: Department of Virology-EA2387 and Infectious Diseases, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Constance
authors.initials: C
authors.lastname: Delaugerre
authors.forename: Laurence
authors.initials: L
authors.lastname: Morand-Joubert
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Chaix
authors.forename: Odile
authors.initials: O
authors.lastname: Picard
authors.forename: Anne-Genevieve
authors.initials: AG
authors.lastname: Marcelin
authors.forename: Veronique
authors.initials: V
authors.lastname: Schneider
authors.forename: Anne
authors.initials: A
authors.lastname: Krivine
authors.forename: Alexandra
authors.initials: A
authors.lastname: Compagnucci
authors.forename: Christine
authors.initials: C
authors.lastname: Katlama
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.forename: Vincent
authors.initials: V
authors.lastname: Calvez
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology*; D004279:DNA, Viral / Q000097:blood; D018562:Disease Transmission, Infectious; D024921:Drug Resistance, Multiple, Viral / Q000235:genetics*; D017809:Fatal Outcome; D005500:Follow-Up Studies; D015751:Genes, pol; D005838:Genotype; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000635:transmission*; D016333:HIV Protease / Q000235:genetics; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006716:Homosexuality; D006801:Humans; D007963:Leukocytes, Mononuclear; D008297:Male; D008875:Middle Aged; D009154:Mutation; D016415:Sequence Alignment
chemical_list: D044966:Anti-Retroviral Agents; D004279:DNA, Viral; D054303:HIV Reverse Transcriptase; D016333:HIV Protease