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HIV-1 group N circulating outside of Cameroon
Delaugerre C. Lancet. 2011;doi:10.1016/S0140-6736(11)61457-8.
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Researchers have identified HIV-1 group N in a 57-year-old man residing in France who reported recent travel to Togo, where infection was suspected to have originated, according to a case report published in The Lancet.
According to background information in the report, HIV-1 group N was first identified in 1998 in a Cameroonian woman with AIDS, and it has since been reported in HIV-infected patients from Cameroon only.
“Until now, HIV-1 group N was considered to be like a wild virus, and with very limited cross-species transmission, only 10 to 12 cases have been reported despite thousands of HIV-infected patients tested in Cameroon to differentiate between M, N or O groups,” François Simon, MD, of Hospital Saint Louis in Paris, told Infectious Disease News. “The report of a group N primary infection indicates that the virus is still circulating today, and the contamination in Togo indicates that HIV-1 group N is getting out of Cameroon and is no longer confined to this remote population.”
In the current case, the patient reported sexual contact with a Togalese partner while visiting Togo. Subsequent symptoms surfaced 8 days after returning to Paris, which led the researchers to infer that the infection was acquired in Togo.
According to Simon, HIV-1 group N was thought to have limited potential to grow at the epidemic level, particularly the viral protein U (Vpu), which was considered unable to down regulate the CD4 expression. “This lack of down regulation was the best explanation for the low prevalence of the strain,” he said.
However, this new case is particularly important because of severe CD4 depletion and high viral load. “The story must be more complicated, which is important for ongoing research,” Simon said.
Although a five-drug antiretroviral combination showed good initial efficacy, the researchers said long-term immunological and virological follow-up is needed.
“This case of HIV-1 group N primary infection indicates that this rare group is now circulating outside Cameroon, which emphasizes the need for rigorous HIV epidemiological monitoring,” they wrote.
Disclosure: The researchers report no relevant financial disclosures.
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