AnonyMs: Got this in the corporate email today and wanted to share it with you all.
Superinfection Can Occur!
Corklin R. Steinhart, MD, PhD
· "Superinfection," i.e. infection with a second strain of HIV during the course of an established HIV infection, thought to be a rare event
· Case report (Jost et al. N Engl J Med. September 5, 2002; 347 (10): 731-36) of a 38 y/o European male who was infected with a different strain (clade) of HIV ~3 years after initial infection
o Infected 11/98 with HIV-1 subtype AE and HBV
o Treated with both HAART and an HIV vaccine with excellent immunologic and virologic responses
o 4/2001 developed mild flu-like illness
§ Had traveled to Brazil and had several unprotected sexual encounters
§ Was off HAART for several months
§ Also determined to have acquired HCV infection as well!
o Had very high viral load for subsequent 3-4 months with profound decrease in CD4 count
o Thorough analysis revealed that he had definitely been infected with a different subtype (B) that lead to rapid progression of disease
o Conclusions
§ Case clearly demonstrates that superinfection can occur
§ Previous HIV infection does not lead to prevention of infection with a different sub-type
§ Supports the use of save sex practices in HIV-infected persons
· Commentary (Goulder and Walker. N ENGL J Med. September 5, 2002; 347 (10): 756-58)
o Previous observations have demonstrated that effective immune responses are generated following acute HIV infection but they are sub-optimal
o The case describe above challenges conventional wisdom that established HIV infection does protect against infection with a second HIV-1 sub-type and, therefore, that a broadly based HIV vaccine could be developed
o However, the frequency of superinfection generally occurring remains unknown
o Does not answer the question of superinfection with the same HIV-1 subtype
o Implications for public health are clear!
§ Infection with one sub-type does not protect against subsequent infection with another sub-type!
§ Superinfection may lead to a more progressive disease course
§ The increased unprotected sexual activity that is presently occurring between HIV-infected persons clearly implies that "vigilance to prevent HIV-1 exposure" is needed in both non-HIV-1 infected and HIV-1 infected persons
o Many questions, however, remain unanswered
Superinfection Can Occur!
Corklin R. Steinhart, MD, PhD
· "Superinfection," i.e. infection with a second strain of HIV during the course of an established HIV infection, thought to be a rare event
· Case report (Jost et al. N Engl J Med. September 5, 2002; 347 (10): 731-36) of a 38 y/o European male who was infected with a different strain (clade) of HIV ~3 years after initial infection
o Infected 11/98 with HIV-1 subtype AE and HBV
o Treated with both HAART and an HIV vaccine with excellent immunologic and virologic responses
o 4/2001 developed mild flu-like illness
§ Had traveled to Brazil and had several unprotected sexual encounters
§ Was off HAART for several months
§ Also determined to have acquired HCV infection as well!
o Had very high viral load for subsequent 3-4 months with profound decrease in CD4 count
o Thorough analysis revealed that he had definitely been infected with a different subtype (B) that lead to rapid progression of disease
o Conclusions
§ Case clearly demonstrates that superinfection can occur
§ Previous HIV infection does not lead to prevention of infection with a different sub-type
§ Supports the use of save sex practices in HIV-infected persons
· Commentary (Goulder and Walker. N ENGL J Med. September 5, 2002; 347 (10): 756-58)
o Previous observations have demonstrated that effective immune responses are generated following acute HIV infection but they are sub-optimal
o The case describe above challenges conventional wisdom that established HIV infection does protect against infection with a second HIV-1 sub-type and, therefore, that a broadly based HIV vaccine could be developed
o However, the frequency of superinfection generally occurring remains unknown
o Does not answer the question of superinfection with the same HIV-1 subtype
o Implications for public health are clear!
§ Infection with one sub-type does not protect against subsequent infection with another sub-type!
§ Superinfection may lead to a more progressive disease course
§ The increased unprotected sexual activity that is presently occurring between HIV-infected persons clearly implies that "vigilance to prevent HIV-1 exposure" is needed in both non-HIV-1 infected and HIV-1 infected persons
o Many questions, however, remain unanswered
