Clinical implications of identifying non-B subtypes of human immunodeficiency virus type 1 infection

E. A. Walter, B. Gilliam, J. A. Delmar, K. Spooner, J. T. Morris, N. Aronson, S. A. Wegner, N. L. Michael, L. L. Jagodzinski

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18 Scopus citations


Although human immunodeficiency virus type 1 (HIV-1) infection in the United States has predominantly involved subtype B, increasing global travel is leading to wider dissemination of genetically heterogeneous subtypes. While physicians depend on HIV-1 viral load measurements to guide antiretroviral therapy, commonly used molecular assays may underestimate the viral load of patients with non-B subtypes. Nine patients with non-B subtypes of HIV-1 were identified by physicians who suspected a non-B subtype on the basis of a low or undetectable HIV-1 viral load, by the Amplicor HIV-1 Monitor test, version 1.0, in conjunction with either a declining CD4 cell count or history of travel outside the United States. Use of version 1.5 of the Amplicor HIV-1 Monitor test detected a median HIV-1 viral load that was 2.0 log10 RNA copies/mL higher than was determined with version 1.0. Clinical management was altered in all cases after diagnosis of a non-B - subtype infection. These cases demonstrate that it is critical for physicians to suspect and diagnose non-B subtypes of HIV-1 so that an assay with reliable subtype performance can be used to guide antiretroviral therapy.

Original languageEnglish
Pages (from-to)798-802
Number of pages5
JournalClinical Infectious Diseases
Issue number3
StatePublished - 2000


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