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July 10, 1996

Transmission of HIV-1 Subtype E in the United States

Author Affiliations

Walter Reed Army Institute of Research
National Naval Medical Center
Naval Medical Research Institute Rockville, Md

JAMA. 1996;276(2):99-100. doi:10.1001/jama.1996.03540020021012

To the Editor.  —The global human immunodeficiency virus type 1 (HIV-1) epidemic comprises infections from at least 9 genetically distinct subtypes or clades of virus (subtypes A through H and subtype 0), and the distribution of subtypes is geographically defined.1 HIV-1 subtype B predominates in North America. The explosive epidemic in Southeast Asia is chiefly attributable to subtype E viruses. We have previously documented multiple introductions of HIV-1 subtype E from endemic areas into the United States and the Western Hemisphere,2,3 raising the possibility that future vaccine strategies may have to consider polyvalent constructs. We now report what we believe to be the first case of domestic transmission of HIV-1 subtype E identified and documented within the United States.

Report of Cases.  —Case 1 is a 23-year-old man who acquired infection with HIV-1 subtype E during overseas military service in Thailand in May 1993.3 Case 2 is