A highly virulent variant of HIV-1 circulating in the Netherlands
Chris Wymant, Daniela Bezemer, François Blanquart, Luca Ferretti, Astrid Gall, Matthew Hall, Tanya Golubchik, Margreet Bakker, Swee Hoe Ong, Lele Zhao, David Bonsall, Mariateresa de Cesare, George MacIntyre-Cockett, Lucie Abeler‐Dörner, Jan Albert, Norbert Bannert, Jacques Fellay, M. Kate Grabowski, Barbara Gunsenheimer‐Bartmeyer, Huldrych F. Günthard, Pia Kivelä, Roger D. Kouyos, Oliver Laeyendecker, Laurence Meyer, Kholoud Porter, Matti Ristola, Ard van Sighem, Ben Berkhout, Paul Kellam, Marion Cornelissen, Peter Reiss, Christophe Fraser, the Netherlands ATHENA HIV Observational Cohort†, Vincent Aubert, Manuel Battegay, Enos Bernasconi, Jürg Böni, Dominique L. Braun, H C Bucher, Claudine Burton‐Jeangros, Alexandra Calmy, Matthias Cavassini, G Dollenmaier, Matthias Egger, Luigia Elzi, Jan Fehr, Jacques Fellay, Hansjakob Furrer, Christoph A. Fux, Meri Gorgievski, Huldrych F. Günthard, David Haerry, Barbara Hasse, Hans H. Hirsch, Matthias Hoffmann, Irène Hösli, Christian R. Kahlert, Laurent Kaiser, Olivia Keiser, Thomas Klimkait, Roger D. Kouyos, Helen Kovari, Bruno Ledergerber, G Martinetti, Begoña Martínez de Tejada, Catia Marzolini, Karin J. Metzner, N Müller, David Nadal, Dunja Nicca, G Pantaleo, Andri Rauch, Stephan Regenass, Christoph Rudin, F. Schöni-Affolter, Patrick Schmid, R Speck, M Stöckle, Philip Tarr, Alexandra Trkola, Pietro Vernazza, Rainer Weber, Sabine Yerly, Mark van der Valk, Suzanne E. Geerlings, Abraham Goorhuis, Joppe W. Hovius, B. Lempkes, F.J.B. Nellen, T. van der Poll, Jan M. Prins, Peter Reiss, Michèle van Vugt, W. Joost Wiersinga, F.W.M.N. Wit, Marlies van Duinen, J. van Eden, A. Hazenberg, A M H van Hes, F J J Pijnappel
Abstract
increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.