Discovery of ‘highly virulent’ HIV variant ‘not a public health crisis’
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Researchers discovered what they described as a “highly virulent” variant of HIV-1 that has been circulating in the Netherlands for the past 2 decades.
Writing in Science, Chris Wymant, PhD, MSc, senior researcher at the University of Oxford’s Big Data Institute, and colleagues explained that they were conducting an ongoing study called the BEEHIVE project when they discovered 17 people with a distinct subtype-B variant of HIV-1 with highly elevated viral loads and an increased risk for transmission.
In an accompanying editorial, Joel O. Wertheim, PhD, an associate adjunct professor of medicine at the University of California, San Diego, said the finding “is not a public health crisis.”
“Standard public health action — including molecular HIV surveillance, facilitating linkage to care, and partner notification — are still the best options when faced with a rapidly growing cluster of more virulent HIV,” Wertheim wrote. “Let us not forget the overreaction of the claim of “Super AIDS” in 2005, when alarm was raised over a rapidly progressing, multidrug-resistant HIV infection found in New York that was ultimately restricted to a single individual.”
To expand on their findings, Wymant and colleagues assessed data from 6,706 participants enrolled in another study and found 92 additional people infected with the variant.
According to the researchers, the 109 total infected people had a viral load that was 3.5 to 5.5 times higher compared with 6,604 people with other subtype-B strains. They also experienced double the rate of CD4 cell count decline.
People with the variant were mostly men who have sex with men (82%), and most were born in Western Europe (86%).
“Most of the evolution that gave rise to [the variant] occurred before 1992, before effective combination treatment was available,” the authors wrote. “However, our findings may stimulate further interest in whether widespread treatment shifts the balance of the infectious-virulence trade-off toward higher virulence, thus promoting the emergence and spread of new virulent variants.”
The number of people infected with the variant increased until approximately 2010, after which there is evidence that its spread has declined, the researchers reported.
References:
Wertheim JO, et al. Science. 2021;doi:10.1126/science.abn4887.
Wymant C, et al. Science. 2021;doi:10.1126/science.abk1688.
Perspective
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We have witnessed and become almost accustomed to the emergence of SARS-CoV-2 variants over the pandemic. Even now, a new omicron variant is being reported.
Fortunately, HIV has seemed amazingly stable by comparison. Although resistant mutant selection under drug pressure is expected and different classes of HIV circulate, often in specific geographical regions, the biologic behavior of HIV and its clinical characteristics have been very predictable. With modest variation, transmission and treatment response are well understood. With the recent report of a possible HIV variant that at first pass may be more transmissible or virulent, we are reminded to be alert for change in nature while also remembering that earlier suggestions of more aggressive HIV forms were not confirmed by further experience. This report should prompt attention but not an early overreaction.
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