Clinical implications of identifying non-B subtypes of human immunodeficiency virus type 1 infection

Clin Infect Dis. 2000 Sep;31(3):798-802. doi: 10.1086/314044. Epub 2000 Oct 4.

Abstract

Although human immunodeficiency virus type 1 (HIV-1) infection in the United States has predominantly involved subtype B, increasing global travel is leading to wider dissemination of genetically heterogeneous subtypes. While physicians depend on HIV-1 viral load measurements to guide antiretroviral therapy, commonly used molecular assays may underestimate the viral load of patients with non-B subtypes. Nine patients with non-B subtypes of HIV-1 were identified by physicians who suspected a non-B subtype on the basis of a low or undetectable HIV-1 viral load, by the Amplicor HIV-1 Monitor test, version 1.0, in conjunction with either a declining CD4 cell count or history of travel outside the United States. Use of version 1.5 of the Amplicor HIV-1 Monitor test detected a median HIV-1 viral load that was 2.0 log(10) RNA copies/mL higher than was determined with version 1.0. Clinical management was altered in all cases after diagnosis of a non-B-subtype infection. These cases demonstrate that it is critical for physicians to suspect and diagnose non-B subtypes of HIV-1 so that an assay with reliable subtype performance can be used to guide antiretroviral therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • CD4 Lymphocyte Count
  • Follow-Up Studies
  • Genotype
  • HIV Infections / blood
  • HIV Infections / diagnosis*
  • HIV Infections / virology
  • HIV-1* / classification
  • HIV-1* / drug effects
  • HIV-1* / genetics
  • Humans
  • Male
  • Military Personnel
  • RNA, Viral / blood
  • RNA, Viral / drug effects
  • Time Factors
  • Viral Load

Substances

  • Anti-HIV Agents
  • RNA, Viral