title: Infection with multidrug resistant, dual-tropic HIV-1 and rapid progression to AIDS: a case report.
abstract: 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.
authors.affiliation: Aaron Diamond AIDS Research Center, Rockefeller University, 455 First Avenue, 7th Floor, New York, NY 10016, USA. mmarkowitz@adarc.org
authors.forename: Martin
authors.initials: M
authors.lastname: Markowitz
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mohri
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mehandru
authors.forename: Anita
authors.initials: A
authors.lastname: Shet
authors.forename: Leslie
authors.initials: L
authors.lastname: Berry
authors.forename: Roopa
authors.initials: R
authors.lastname: Kalyanaraman
authors.forename: Alexandria
authors.initials: A
authors.lastname: Kim
authors.forename: Chris
authors.initials: C
authors.lastname: Chung
authors.forename: Patrick
authors.initials: P
authors.lastname: Jean-Pierre
authors.forename: Amir
authors.initials: A
authors.lastname: Horowitz
authors.forename: Melissa
authors.initials: M
authors.lastname: La Mar
authors.forename: Terri
authors.initials: T
authors.lastname: Wrin
authors.forename: Neil
authors.initials: N
authors.lastname: Parkin
authors.forename: Michael
authors.initials: M
authors.lastname: Poles
authors.forename: Christos
authors.initials: C
authors.lastname: Petropoulos
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
authors.forename: Daniel
authors.initials: D
authors.lastname: Boden
authors.forename: David D
authors.initials: DD
authors.lastname: Ho
mesh_terms: 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
chemical_list: D019713:Receptors, CCR5; D019718:Receptors, CXCR4