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Comments, Opinions, and Brief Case Reports
October 8, 2001

Primary Infection With a Multidrug-Resistant HIV-1 Strain

Arch Intern Med. 2001;161(18):2259-2260. doi:

Drug resistance may be the main cause of antiretroviral treatment failure in human immunodeficiency virus (HIV) infection. Drug-resistant mutations have been described for all 3 classes of antiretroviral drugs. The first case of sexual transmission of a multidrug-resistant variant (MDR) was published in 1998.1 We report a new case.

On November 14, 1998, a 24-year-old man was admitted for a prostate infection and an anal fistula. He had had unprotected receptive anal intercourse with a male partner 3 days earlier. The anal fistula was treated surgically, and therapy with ofloxacin was started. Pharyngitis and fever developed. A serologic assay for HIV was negative. Amoxicillin was added to his therapy regimen, and the patient was discharged on November 21, 1998. Two days later a maculopapular rash developed, prompting the substitution of ofloxacin and amoxicillin with co-trimoxazole (sulfamethoxazole and trimethoprim). Five days later diffuse urticaria occurred.

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