The subject of the case study was a middle-aged homosexual man who reported that his only risk encounter in the six months prior to being infected with HIV was receptive anal intercourse without a condom. He said his partner had withdrawn before ejaculation, a behavior that many in the gay community have considered to be a low-risk practice.
"There may be a tendency to feel complacent because of the success of treatment efforts," Hecht said, "but the fact that this transmission occurred by a practice that many consider to be 'safe' highlights the crucial role of continued prevention efforts needed to control the HIV epidemic."
With the patient's consent, the researchers obtained information from his partner. He was diagnosed with HIV infection in 1990, and since then was sporadically treated with nine anti-retroviral drugs, including reverse transcriptase inhibitors and protease inhibitors.
Hecht said that interruptions in the partner's treatment may have contributed to the development of resistant HIV that was transmitted to the patient.
"This study shows that we can do more harm than good if we don't help patients take their medications correctly," said Margaret Chesney, PhD, professor of medicine at UCSF, a co-investigator of the study, and an expert on adherence issues. "The bottom line is that helping patients stick to these difficult regimens is as important as the drugs themselves."
To examine the sensitivity and resistance of the patient's virus to the 11
approved HIV anti-retrovirals, the researchers used a novel phenotypic drug
susceptibility assay developed by ViroLogic, Inc., a biotechnology company
located in South San Francisco, Calif. The technique uses a retroviral vector
that contains a viral gene segment from the patient's virus and an indicator, to
measure the sensitivity of the patient's v
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Contact: Mitzi Baker
mabaker@itsa.ucsf.edu
(415) 476-2557
University of California - San Francisco
1-Jul-1998