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Journal of Virology, December 2003, p. 12921-12926, Vol. 77, No. 23
0022-538X/03/$08.00+0     DOI: 10.1128/JVI.77.23.12921-12926.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Infection with Multiple Human Immunodeficiency Virus Type 1 Variants Is Associated with Faster Disease Progression

Divisions of Human Biology,¹ Public Health Sciences, Fred Hutchinson Cancer Research Center,⁵ Departments of Medicine,² Epidemiology,³ Biostatistics, University of Washington, Seattle, Washington,⁶ Department of Medical Microbiology, University of Nairobi, Nairobi,⁴ Coast Provincial General Hospital, Mombasa, Kenya⁷

Received 28 April 2003/ Accepted 23 August 2003

Human immunodeficiency virus type 1 (HIV-1)-infected individuals develop a genetically diverse virus population over time, but often only a limited number of viral variants are transmitted from a chronic carrier to a newly infected person. Interestingly, many women but few men are infected by multiple HIV-1 variants from a single partner. To determine whether the complexity of the infecting virus population influences clinical outcome, we examined viral diversity in the HIV-1 envelope sequences present at primary infection in 156 women from Kenya for whom we had follow-up data on viral RNA levels and CD4 T-cell counts. Eighty-nine women had multiple viral genotypes, while 67 women had a single genotype at primary infection. Women who acquired multiple viral genotypes had a significantly higher viral load (median, 4.84 versus 4.64 log₁₀ copies/ml, P = 0.04) and a significantly lower CD4⁺-T-cell count (median, 416 versus 617 cells/mm³, P = 0.01) 4 to 24 months after infection compared to women who were infected with a single viral genotype. These studies suggest that early HIV-1 genetic diversity is linked to faster disease progression.

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