3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

“PATIENT ZERO”: THE CONNECTICUT SOURCE OF THE MULTI-DRUG RESISTANT, DUAL-TROPIC, RAPIDLY PROGRESSING HIV-1 STRAIN FOUND IN NYC

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. MoOa0101

Blick G.¹, Greiger-Zanlungo P.², Heseltine P.³, Kagan R.³, Garton T.¹, Arzu Z.^1
1Circle Medical LLC, Norwalk, United States Of America; ²New York Medical College/Mount Vernon Hospital, Mt. Vernon, United States Of America; ³Quest Diagnostics/Nichols Laboratory, San Juan Capistrano, United States Of America

INTRODUCTION: Reports of a highly multi-drug resistant(MDR-HIV), dual-tropic, rapidly progressing strain of HIV-1 (VRC:136%) transmitted to a NYC male (“NYC”) raised public health concerns internationally. The source of this strain was previously unknown.

METHODS: Viral sequence analyses of >135,000 HIV isolates were examined. Clinical and laboratory summaries regarding strains precisely matching the MDR strain idenitified an HIV/AIDS patient in Connecticut likely associated with the transmission.

RESULTS: “Patient Zero(CT)” is a 52yo caucasian MSM from Connecticut, HIV+ 10/93, who began AZT monotherapy in 1995 with CD4 95, followed by AZT/SQV-hgc, prior to beginning HAART in 1997. Past ARV included AZT/d4T/ABC/3TC/ddI/TDF; EFV/NVP; RTV/SQV-hgc and –sgc/LPV/r/APV/NFV. Past history includes rectal condyloma, syphilis, and CA-MRSA from 2002-2004, and multiple metabolic complications. “CT” practices multiple partner unprotected anal-receptive/anal-insertive intercourse with his male partner of >10yrs at multiple venues and occasionally uses crystal methamphetamine. In 2/04, he began T-20/EFV/SQV-hgc/r/ddI/d4T/ABC. PCR decreased from 50,000 to <400c/ml by Mo.4, with CD4 increasing 170-310cells/mm³. Following 4 days of T-20 noncompliance, PCR rose to 1451c/ml in 10/04; Phenotypic/genotypic analysis revealed NRTI:M41L,D67N,V118I,M184V, L210W,T215Y; nNRTI:K101E,Y181I; PI:L10I,L33F,E34Q,M46I,I54M,L63P,A71V,G73S,V771,I84V,L89V, L90M, fully susceptible to EFV and DLV and identical to "NYC"´s phenotype/genotype. T-20 susceptibility was confirmed. Also in 10/04, “CT” and partner had unprotected anal-insertive intercourse with “NYC” while using crystal methamphetamine. “NYC” confirmed the sexual contact with “CT” through descriptive history. Phylogenetic analyses confirmed “CT”’s strain identical to “NYC”’s isolate, and dual tropism was confirmed. However, in 10/04, “CT” had a VRC=41%, and, while now fully adherent to HAART, has CD4%10-13, CD4#180-262, and PCR<400.

CONCLUSIONS: Analyses confirm “CT”’s HIV-1 identical to the isolate from “NYC”. While acute infection resulted in rapid progression to AIDS in “NYC”, HIV-1 viremia is well-controlled, CD4 remains stable, and VRC=41% in "CT", refuting the concept of a new aggressive HIV strain, while suggesting host factors may best explain the rapid progression to AIDS in "NY".

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