Journal Article

Clinical Implications of Identifying Non-B Subtypes of Human Immunodeficiency Virus Type 1 Infection

Elizabeth A. Walter, Bruce Gilliam, Judy A. Delmar, Katherine Spooner, Joseph T. Morris, Naomi Aronson, Scott A. Wegner, Nelson L. Michael and Linda L. Jagodzinski

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 31, issue 3, pages 798-802
Published in print September 2000 | ISSN: 1058-4838
Published online September 2000 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/314044
Clinical Implications of Identifying Non-B Subtypes of Human Immunodeficiency Virus Type 1 Infection

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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 log10 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.

Journal Article.  3659 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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