AIDSWEEKLY Plus, Monday, 11 August 1997
Daniel J. DeNoon, Senior Editor
The first HIV-1 subtype G infection in the United States - and the second U.S. HIV-1 group O infection - were identified in the state of Maryland, the U.S. Centers for Disease Control and Prevention (CDC) reported.
Both viruses were reactive with normal HIV tests. The CDC warned, however, that this may not always be the case.
"Physicians should be aware that genetic subtypes of HIV influence laboratory characterization of HIV infection," wrote CDC researcher Patrick S. Sullivan and colleagues. "Although HIV infection was detected by routine serology in both of these cases, infections with HIV-1 group O may not be detected and some HIV enzyme immunoassay tests may be less sensitive in detecting window-period infections with HIV-1 subtypes A, E, and G compared with subtype B infections [the predominant HIV- 1 subtype in the U.S. and western Europe]."
Sullivan et al. reported the findings in a letter to The Journal of the American Medical Association ("Surveillance for Variant Strains of HIV: Subtype G and Group O HIV-1," JAMA, 1997;278:292).
The patient with subtype G HIV-1 infection was born in West Africa but her infection was diagnosed in the U.S. in the early 1990s. The woman, in her mid-30s, probably acquired the infection via heterosexual intercourse in Africa. She died with severe immune suppression and AIDS-related opportunistic infections.
This patient's plasma was reactive on both the Genetic Systems and Dupont enzyme immunoassay tests. It was also reactive for HIV-1 proteins p17, p24, p32, gp41, p51, p65, gp120, and gp160 on Western blot tests. Sequencing showed that the C3V3 region of the env gene and the p17 region of the gag gene were similar to prototypic subtype G strains of the virus.
The patient with group O infection was born in Central Africa and was also probably infected via heterosexual intercourse in Central Africa. This woman, in her mid-40s, is severely immunosuppressed but has no AIDS-defining condition. She said she had not donated any blood.
This patient's sera was reactive with the HIV enzyme immunoassay tests made by Genetic Systems, Organon Teknika, and Ortho Biotech. It was also reactive for HIV-1 proteins p17, p24, p32, gp41, p51, p65, gp120, and gp160 on Western blot tests. Sequences from the env, gag, and protease genes were similar to prototypic group O strains.
Sullivan et al. warned that RNA amplification tests may underestimate viral loads for patients infected with HIV-1 subtypes A, E, F, and G.
"If patients may have been HIV infected outside the United States, have symptoms suggestive of immunosuppressive disease, and are repeatedly HIV enzyme immunoassay test nonreactive, further diagnostic tests to rule out infection with non-B subtypes of HIV-1 or HIV-1 may be appropriate," they suggested.
The corresponding author for this letter is Patrick S. Sullivan, U.S. Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
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