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15 August 2007

Volume 45, Number 4
Clinical Infectious Diseases 2007;45:501–509
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4504-0018$15.00
DOI: 10.1086/520024
HIV/AIDS MAJOR ARTICLE

HIV Type 1 Superinfection with a Dual‐Tropic Virus and Rapid Progression to AIDS: A Case Report

Geoffrey S. Gottlieb,1,2

David C. Nickle,3

Mark A. Jensen,3,a

Kim G. Wong,3

Richard A. Kaslow,4,5,6

James C. Shepherd,7,a

Joseph B. Margolick,8 and

James I. Mullins1,2,3

1Division of Allergy and Infectious Diseases and Departments of 2Medicine and 3Microbiology, School of Medicine, University of Washington, Seattle; Departments of 4Epidemiology, 5Medicine, and 6Microbiology, University of Alabama at Birmingham; and 7Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, and 8Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland

Background.The occurrence of human immunodeficiency virus type 1 (HIV‐1) superinfection has implications for vaccine development and our understanding of HIV pathogenesis and transmission.

Methods and Results.We describe a subject from the Multicenter AIDS Cohort Study who was superinfected with a dual‐tropic (CXCR4/CCR5‐utilizing) HIV‐1 subtype B strain between 0.8 and 1.3 years after seroconversion who had rapid progression to AIDS; the subject developed Pneumocystis pneumonia 3.4 years after seroconversion, as well as multiple other opportunistic infections. The superinfecting strain rapidly became the predominant population virus, suggesting that the initial and superinfecting viruses in this individual differed in virulence. However, we found no molecular epidemiological evidence in the HIV database to suggest that this strain had been found in other individuals. In addition, this subject’s HIV‐1 viral load and pattern of human leukocyte antigen and coreceptor polymorphisms only partially explained his rapid disease progression.

Conclusions.Additional studies are needed to determine whether superinfection itself and/or infection with a dual‐tropic virus causes rapid disease progression, or whether certain individuals who are innately more susceptible to rapid disease progression also lack the ability to resist the challenge of a second infection. This case appears to support the latter hypothesis.

Received 9 January 2007; accepted 20 April 2007; electronically published 10 July 2007.

Reprints or correspondence: Dr. Geoffrey S. Gottlieb, Div. of Allergy and Infectious Diseases, Dept. of Medicine, University of Washington, Seattle, WA 98195 ().

Cited by

Rebecca L R Powell, Mateusz M Urbanski, Sherri Burda, Thompson Kinge, Phillipe N Nyambi. (2009) High Frequency of HIV-1 Dual Infections Among HIV-Positive Individuals in Cameroon, West Central Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes 50:1, 84-92
Online publication date: 1-Feb-2009.
CrossRef
Rebecca L. R. Powell, Mateusz M. Urbanski, Sherri Burda, Aubin Nanfack, Thompson Kinge, Phillipe N. Nyambi. (2008) Utility of the Heteroduplex Assay (HDA) as a Simple and Cost-Effective Tool for the Identification of HIV Type 1 Dual Infections in Resource-Limited Settings. AIDS Research and Human Retroviruses 24:1, 100-105
Online publication date: 1-Feb-2008.
CrossRef

  • Present affiliations: Department of Health Administration, Biostatistics, and Epidemiology and Department of Genetics, University of Georgia, Athens (M.A.J.); Division of Geographic Medicine, Department of Medicine, University of Maryland, Baltimore (J.C.S.).

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