As HIV infections spread globally, local epidemics in different g

As HIV infections spread globally, local epidemics in different geographical areas and risk groups

emerged, which were dominated by a single subtype or CRF [1, 2]. As more viral mixing has occurred a plethora of untypable and unique recombinants have emerged, confusing the picture further [3]. There are a number of techniques for identifying subtype but the gold standard is viral genome sequencing. In clinical practice, the subtype is usually supplied as a by-product of a genotypic test for resistance. However, this should be interpreted with caution because the pol. gene only reflects the genetic composition of a small region of the viral genome. Furthermore, different algorithms using the same sequence data can produce discrepant selleck kinase inhibitor results. At present the REGA HIV-1 subtyping tool [4] is generally regarded as the Omipalisib supplier gold standard for web-based systems. Unless superinfection occurs, the viral subtype will not change during the course of disease. Epidemiologically, there is interest in viral subtypes as they provide information on the dynamics of the

epidemic at national and international levels. Currently, subtype does not provide much guidance for individual patient management. There are, however, a number of issues surrounding subtype that have attracted significant attention Thiamet G [1, 2]. There is limited evidence that some subtypes cause more aggressive disease than others, with faster disease progression [5-8]. Anecdotal evidence of greater transmissibility of some subtypes has not been substantiated [9]. Subtype-related sequence variability can affect the performance of viral load and genotypic and phenotypic drug resistance and tropism assays. Antiretroviral drugs were designed for, tested on and predominantly used on infections with subtype B, which has been historically the

dominant virus in the USA and Europe. There was concern that some subtypes may be inherently less responsive to certain therapies [10, 11]. However, there is now clear evidence that the excellent virological and immunological outcomes achieved with highly active antiretroviral therapy (HAART) do not differ among the predominant subtypes [12]. Although certain resistance mutations are more common in some subtypes than others, major mutations conferring resistance in subtype B also confer resistance in prevalent non-B subtypes and vice versa [13]. Subtle effects cannot be excluded, however, and rarer subtypes may show novel patterns. HIV gains entry into cells that express CD4 and one of two main transmembrane co-receptors, either CCR5 or CXCR4. The preferential use of one of the co-receptors is determined by the V3-loop of the envelope protein gp120.

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