title: Two cases of possible transmitted drug-resistant HIV: likely HIV superinfection and unmasking of pre-existing resistance.
abstract: In the UK, patients undergo HIV viral load and genotype testing before they are prescribed antiretroviral therapy. The genotype test guides clinicians in prescribing antiretroviral therapy with maximum efficacy against the patient's specific viral strain. HIV viral load escape under antiretroviral drug therapy, to which the virus was thought to be genotypically susceptible, is commonly observed in patients with poor adherence. We observed early viral escapes in two-newly diagnosed patients, during antiretroviral treatment, with different sequences compared to their original viral resistance test and who reported excellent adherence to and tolerance of their therapy. HIV superinfection with a new viral strain was identified in a patient with multiple risk factors and co-infections with sexually transmitted infections. The second patient was a case of the emergence of primary resistant virus under drug pressure. Both suppressed their virus promptly after treatment switch.
authors: Centre for Immunology and Infection, Department of Biology, University of York, York, UK Fabiola.martin@hyms.ac.uk.
authors: Fabiola
authors: F
authors: Martin
authors: Genitourinary Department, Josephine Butler Centre King Street Health Centre, Wakefield, UK.
authors: John
authors: J
authors: Lee
authors: Centre for Virus Research, University of Glasgow, Glasgow, UK.
authors: Emma
authors: E
authors: Thomson
authors: Genitourinary Department, York Teaching Hospital, York, UK.
authors: Nick
authors: N
authors: Tarrant
authors: Department of Virology, Leeds Teaching Hospitals Trust, Leeds, UK.
authors: Antony
authors: A
authors: Hale
authors: Centre for Immunology and Infection, Department of Biology, University of York, York, UK.
authors: Charles J
authors: CJ
authors: Lacey
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D060085:Coinfection / Q000188:drug therapy / Q000821:virology; D024882:Drug Resistance, Viral / Q000235:genetics*; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D015163:Superinfection / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
keywords: AIDS; HIV; Transmitted drug resistance; antiviral; dual infection; hepatitis C; high-risk behaviour; highly active antiretroviral therapy; minority species; superinfection; syphilis (Treponema pallidum); viral disease