- LB2: Documentation of HIV-1 Superinfection and Acceleration of Disease Progression (Authored by J.B. Angel, S. Kravcik, E. Balaskas, P. Yen, A.D. Badley, D.W. Cameron, and Y.-W. Hu. Ottawa Hosp. and Canadian Blood Services, Ottawa, Canada)
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HIV-1 Super infection: Myth or Menace?
In this late breaker session on the final day of the 7th Annual Conference on Retroviruses and Opportunistic Infections, Dr. Johnathan Angel presented documentation regarding a suspected infection of a super strain of HIV-1. This "super strain" is resistant to all current HAART regimens, and leads to rapid advance of HIV disease in the infected person. Dr. Angel described a situation where one person (Patient A) with non-progressive HIV infection, was re-infected by a second person (Patient B) with an HIV infection containing several drug resistant mutations in their virus.
In the study, Patient A met Patient B in 1997 and they began having a relationship. This relationship included unprotected sexual intercourse since both of them were already HIV positive. During the course of their relationship, Patient A -- whose HIV had been non-progressive for several years -- suddenly experienced a rapid decline in CD4 counts and a dramatic increase in viral load. Following initiation of HAART, which included a protease inhibitor, Patient A failed to respond to treatment.
Blood samples were taken from both Patients A and B. The samples were then compared to determine if Patient A had been infected with a super-resistant strain of HIV from patient B. A phylogenetic analysis of the blood samples identified a positive correlation between the point mutations in the virus in both Patient A and B, leading to the conclusion that Patient A was very likely infected with a resistant strain of HIV-1 by Patient B.
If confirmed, this would be the first documented report of what appears to be infection of an HIV-1 super virus in a person already infected with HIV-1. This report poses serious questions as to the safety of unprotected sex between people who are both HIV+ and on HAART. While many people who are HIV+ are making the choice to have unprotected sex with others who are also HIV+, such decisions could be putting them at great risk of acquiring a super virus which is resistant to current FDA approved therapies. More studies need to be done to conclusively verify that super infections do in fact occur in people, and, if proven, a massive prevention campaign needs to be undertaken to educate HIV+ people about the risks posed by having unprotected sex with other HIV+ people.
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