- AIDS Alert www.ahcpub.com Vol. 16, No. 2, P. 24 2-7-1
- An unusual occurrence of HIV drug mutations was noted
recently in the examination of a Texas prisoner infected with HIV. The
prisoner became infected with the virus while incarcerated, and within
one year developed the nine HIV drug mutations despite having never received
any antiretroviral drug therapy. "So this is the first report of transmission
of highly resistant virus during primary infection in prisons," notes
Dr. William O'Brien of the University of Texas Medical Branch and Division
of Infectious Diseases in Galveston.
- O'Brien discovered the unusual case while doing a comparison
study of prison inmates and university patients. He found that members
of both patient populations who tested with a higher than a 5,000 viral
copy level, showed a significantly high level of resistance mutation, especially
patients exposed to the drug 3TC. At this point, the primary difference
between the two patient populations was that the incidence of mutation
was higher at 80 percent in the prison population versus 50 percent within
the university patient group.
- While O'Brien was collecting his data, he encountered
an inmate record that indicated the man exhibited high risk behaviors for
infection although he had tested HIV-negative several times. In early 1997,
the inmate finally tested HIV- positive but was never placed in any kind
of drug therapy program. Less than one year later, blood tests revealed
that the virus had mutated into nine different drug resistant strains,
and then again another year later, the same nine strains were identified.
O'Brien notes that when a patient is not receiving drug therapy, resistant
mutations generally disappear over time, because the virus is able to grow
faster without them.
- He adds, "I've been cautioning patients for years
that even if they already have HIV, it's theoretically possible they could
get a virus that's worse than the one they already have." The findings
also indicate that clinicians consider resistance testing prior to starting
therapy for patients whose risk behaviors increase the likelihood that
they were exposed to drug-resistant strains.
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