New highly virulent HIV variant highlights need for early detection

A new HIV variant impacts the immune system twice as quickly as other variants, making early detection and treatment key factors.

 Scanning electron micrograph of HIV-1 budding (in green) from cultured lymphocyte. (photo credit: VIA WIKIMEDIA COMMONS)
Scanning electron micrograph of HIV-1 budding (in green) from cultured lymphocyte.

A new highly virulent variant of HIV (human immunodeficiency virus) has been discovered in the Netherlands. Researchers have stressed that existing treatments still work well with the new variant.

In a study published in the peer-reviewed journal Science on Thursday, a team led by researchers at the University of Oxford wrote that the new variant, dubbed the VB variant, led to a viral load between three to five times higher than other variants. The VB variant also decreased CD4 white blood cell counts (the hallmark of immune system damage by HIV) twice as fast as other variants.

The new variant also has an increased transmission rate.

The researchers found that within just nine months, patients in their 30s with the VB variant had CB4 cell counts of 350 cells/mm3. Patients with other variants only reached that level after 36 months on average. Among older patients, the decline happened more quickly.

Previous studies have found that initiating treatment at that level and not earlier increases the risk for serious adverse events, meaning that early detection and treatment are key with those infected with the VB variant of HIV. However, as long as treatment is administered, patients with the VB variant show similar survival and immune recovery rates as non-VB patients.

A student makes an AIDS red ribbon during a World AIDS Day event in Beijing, December 1, 2010 (credit: JASON LEE / REUTERS)A student makes an AIDS red ribbon during a World AIDS Day event in Beijing, December 1, 2010 (credit: JASON LEE / REUTERS)

Researchers additionally stressed the importance of having HIV testing accessible to at-risk individuals as beginning treatment as quickly as possible prevents transmission and the advancement of illness to AIDS (acquired immunodeficiency syndrome). They added that while in the Netherlands testing is highly accessible, the VB variant could be of concern in areas where testing and awareness about the virus is lower, meaning detection can take longer.

"Our findings emphasize the importance of World Health Organization guidance that individuals at risk of acquiring HIV have access to regular testing to allow early diagnosis, followed by immediate treatment," said senior author Professor Christophe Fraser in a press release by the University of Oxford's Big Data Institute. "This limits the amount of time HIV can damage an individual’s immune system and jeopardize their health. It also ensures that HIV is suppressed as quickly as possible, which prevents transmission to other individuals."

The VB variant first surfaced in the 1990s before effective treatments for HIV were available. While it spread more quickly than other variants in the 2000s, its spread has been declining since 2010.

Referring to discussions about how widespread treatment affects how virulent new variants are, the researchers concluded that widespread treatment helps prevent new virulent variants as it prevents variants from transmitting onwards.

"Put simply, 'viruses cannot mutate if they cannot replicate' (anonymous), and 'the best way to stop it changing is to stop it' [Marc Lipsitch]," wrote the researchers.

"Before this study, the genetics of the HIV virus was known to be relevant for virulence, implying that the evolution of a new variant could change its impact on health," said lead author Dr. Chris Wymant in a press release by the Big Data Institute. "Discovery of the VB variant demonstrated this, providing a rare example of the risk posed by viral virulence evolution."

Joel Wertheim, an evolutionary biologist and molecular epidemiologist at the University of California San Diego, told Nature that while the new variant is a "reason to stay vigilant," it's not a public health crisis as it's not resistant to current treatments.

The news of the new variant comes just days after Moderna announced that it had begun the Phase I Trial for an mRNA HIV vaccine developed by it and the nonprofit scientific research organization IAVI.

In July, the University of Oxford began the Phase I trial of its own HIV vaccine known as the HIVconsvX vaccine. Instead of inducing antibodies generated by B-cells like other vaccine candidates, the Oxford vaccine works by inducing the immune system's T cells targeting them to vulnerable parts of HIV to allow them to combat the virus.

Last summer, Israel's AIDS Task Force issued statements urging Israelis to follow safe sex practices, after they noticed a jump in positive HIV tests compared to previous months.

The task force stressed that many of those who tested positive stated that they had sex without a condom with a partner who claimed that he was on PrEP (pre-exposure prophylaxis), a medicine used to prevent contracting HIV from sex or injection drug use. While official data on the reports is not yet available, a number of doctors have described similar cases.

PrEP is a drug that only protects the person who takes it and only if taken accurately. If taking PrEP on-demand, the task force recommends taking two PrEP pills at once, at least two hours before having sex. Protection should last up to 24 hours, as long as you take another pill 24 hours after taking the first two pills and then a third pill 24 hours after the second.

The task force emphasized that using PrEP on demand is not approved by Israel's Health Ministry, which recommends taking PrEP daily in order to best prevent infection. The task force stressed that those having sex should wear condoms.

Those interested in starting PrEP should consult their physician before starting and should not attempt to obtain the drug in another way. PrEP is part of the health basket in Israel, meaning that it is provided at a subsidized price by HMOs.