title: The probable source of both the primary multidrug-resistant (MDR) HIV-1 strain found in a patient with rapid progression to AIDS and a second recombinant MDR strain found in a chronically HIV-1-infected patient.
abstract: BACKGROUND
  Rapid progression to AIDS after acute infection with a multidrug-resistant (MDR), dual-tropic strain of human immunodeficiency virus type 1 (HIV-1) was reported in a New York City man (hereafter referred to as "NYC") who has sex with men. The probable source of this HIV-1 (hereafter referred to as "CT01") and the development of a recombinant MDR HIV-1 in the source's partner (hereafter referred to as "CT02") are described.
  
  
  METHODS
  After identification of the epidemiological link of CT01 and CT02 to NYC, viral sequences and phenotypic analyses were compared. Confirmatory genotypic and phenotypic analyses, replicative capacity, and viral coreceptor use were assessed. Viral recombination was assessed using a sliding window technique and phylogenetic tree analysis.
  
  
  RESULTS
  NYC and CT01 were linked historically and epidemiologically and were genetically confirmed from CT01's samples acquired 2 days before and subsequent to the transmission event. Genotypic, recombination, and phylogenetic analyses suggest CT02 became superinfected by CT01 with subsequent production of a recombinant panresistant HIV-1.
  
  
  CONCLUSIONS
  The probable source of a dual-tropic, MDR HIV-1 that was associated with rapid progression to AIDS is illustrated, suggesting progression was not explained by the HIV-1 variant alone. A probable second finding of a chronically infected host becoming superinfected with MDR HIV-1 with subsequent formation of a panresistant recombinant HIV-1 is described. This case illustrates the public health implications of unsafe sex between serodiscordant and seroconcordant partners.
authors.affiliation: Circle Medical LLC, Norwalk, CT 06851, USA. BlickMD@CircleMedical.org
authors.forename: Gary
authors.initials: G
authors.lastname: Blick
authors.forename: Ron M
authors.initials: RM
authors.lastname: Kagan
authors.forename: Eoin
authors.initials: E
authors.lastname: Coakley
authors.forename: Christos
authors.initials: C
authors.lastname: Petropoulos
authors.forename: Laura
authors.initials: L
authors.lastname: Maroldo
authors.forename: Paola
authors.initials: P
authors.lastname: Greiger-Zanlungo
authors.forename: Scott
authors.initials: S
authors.lastname: Gretz
authors.forename: Trish
authors.initials: T
authors.lastname: Garton
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D018450:Disease Progression; D024921:Drug Resistance, Multiple, Viral / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D009154:Mutation / Q000235:genetics; D009519:New York City / Q000453:epidemiology; D010802:Phylogeny; D012689:Sequence Homology, Nucleic Acid; D012747:Sexual Partners
chemical_list: D019380:Anti-HIV Agents