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Drug Resistant HIV in NYC Evolution and Recombination

Recombinomics Commentary
March 30, 2005

>> Because the investigation is continuing, Dr. Frieden would not say precisely how the strains that might be related to the New York City case were found. Some may have been discovered as a result of identifying men with whom the New York man had sex, but it is just as likely that they were detected in the department's canvassing of laboratories that do H.I.V. research and testing.

In all, one health official said, investigators have identified "fewer than 10" patients whose strains may be related to the New York City man.
Work has already begun, with the help of the Centers for Disease Control in Atlanta and the Aaron Diamond AIDS Research Center in Manhattan, to sequence the genome of the possibly related cases, Dr. Frieden said.
The source of the New York man's infection remains unknown, officials said. <<

The investigation of NYC cases for the source of 3-DCR NYC is ongoing, but it seems increasingly likely that 3-DCR NYC is a recombinant and may have actually been created within the NYC patient.  In his last test before the fall of 2004 he was HIV negative.  Included among his partners was a CT man who also was infected with HIV resistant to 19 of 21 FDA approved drugs.

The NYC investigation has identified several additional patients infected with HIV that is drug resistant.  However, like the CT partner, these men also were HIV+ prior to having sex with the NYC patient.

Thus, it is possible that he was infected with one virus that had a high replication capacity and another that was 3-DCR and the resulting recombinant had both properties.

Testing of these partners may be difficult since they were already infected and the new recombinant may be part of a mixture of viruses complicating the analysis. 

However, the dual infections that result from sex between two HIV+ individuals may speed up the evolution of resulting recombinants which will further limit treatment options.

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