Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report.
BACKGROUND
Rapid progression to AIDS after acute HIV-1 infection, though uncommon, has been noted, as has the transmission of multidrug resistant viruses. Here, we describe a patient in whom these two factors arose concomitantly and assess the effects.


METHODS
We did a case study of a patient with HIV-1 seroconversion. We genotyped the virus and host genetic markers by PCR and nucleotide sequencing. To ascertain the drug susceptibility of our patient's HIV-1 we did phenotypic studies with the PhenoSense assay. We assessed viral coreceptor use via syncytium formation in vitro and with a modified PhenoSense assay.


RESULTS
Our patient seems to have been recently infected by a viral variant of HIV-1 resistant to multiple classes of antiretroviral drugs. Furthermore, his virus population is dual tropic for cells that express CCR5 or CXCR4 coreceptor. The infection has resulted in progression to symptomatic AIDS in 4-20 months.


CONCLUSIONS
The intersection of multidrug resistance and rapid development of AIDS in this patient is of concern, especially in view of his case history, which includes high-risk sexual contacts and use of metamfetamine. The public health ramifications of such a case are great.
Markowitz
Martin
M
Aaron Diamond AIDS Research Center, Rockefeller University, 455 First Avenue, 7th Floor, New York, NY 10016, USA. mmarkowitz@adarc.org
Mohri
Hiroshi
H
Mehandru
Saurabh
S
Shet
Anita
A
Berry
Leslie
L
Kalyanaraman
Roopa
R
Kim
Alexandria
A
Chung
Chris
C
Jean-Pierre
Patrick
P
Horowitz
Amir
A
La Mar
Melissa
M
Wrin
Terri
T
Parkin
Neil
N
Poles
Michael
M
Petropoulos
Christos
C
Mullen
Michael
M
Boden
Daniel
D
Ho
David D
DD
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000821:virology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D024921:Drug Resistance, Multiple, Viral; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000737:chemistry / Q000187:drug effects / Q000235:genetics / Q000502:physiology; D006801:Humans; D008297:Male; D019713:Receptors, CCR5 / Q000032:analysis; D019718:Receptors, CXCR4 / Q000032:analysis; D016176:T-Lymphocyte Subsets; D014779:Virus Replication
D019713:Receptors, CCR5; D019718:Receptors, CXCR4