Where Do Drug-Resistant HIV Minority Variants Come From?

A careful analysis provides evidence for transmission of minority variants.

HIV drug–resistance mutations present in <20% of the viral population — minority variants (MVs) — are often not detected on commercial assays and have been linked to a higher rate of virologic failure (NEJM JW AIDS Clin Care Jan 28 2013). However, whether MVs are transmitted or develop de novo because of HIV's rapid and error-prone replication remains unknown.

To assess for evidence of transmission, investigators in Switzerland used sensitive assays to test samples from 204 acute or recent HIV seroconverters and 382 treatment-naive patients with chronic HIV infection for MVs. They also carried out phylogenetic sequence analyses to identify transmission clusters.

Several findings indicated that MVs were transmitted:

In patients with recently ac…

Reviewing Author

Rajesh T. Gandhi, MD

Disclosures

Grant/Research SupportNIH

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Leadership Positions in Professional SocietiesHIV Medicine Association; Infectious Diseases Society of America (Board of Directors)