Prolonged retention of drug resistance mutations and rapid disease progression in the absence of therapy after primary HIV infection

We report two separate, unrelated instances of the transmission of HIV-containing mutations associated with high levels of resistance to pro-tease inhibitors or reverse transcriptase inhibitors. In the absence of antiretroviral drugs, these mutations persisted almost unchanged in the newly infected index cases, whereas most mutations reverted to wild type in the source patients upon discontinuation of therapy. Furthermore, a rapid loss of CD4 cells was observed in the newly infected individuals.