Changing transmission fitness of drug-resistant human immunodeficiency virus against a background of evolving antiretroviral therapy.

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Abstract
To the Editor —Leigh Brown et al. [1] present data on the prevalence of drug-resistant human immunodeficiency virus (HIV) in patients with acute HIV infection attending San Diego and Los Angeles clinics during 2 periods, 1996–1998 and 1999–2000. By estimating the percentage of HIV-infected individuals who have virus above a minimal transmissible level (1000 HIV RNA copies/mL) and the fraction of these individuals who have drug-resistant virus, they estimate the percentage of drug-resistant virus that should appear in newly infected individuals if wild-type and drug-resistant virus are equally transmissible. For 1997, this calculation produces the finding that ∼30% of transmissible viruses have a drug-resistant genotype. On the other hand, only 6% of cases of primary infection are drug-resistant, leading to the conclusion that drug-resistant virus is transmitted only 20% (6%/30% × 100%) as often as expected. The implication from this finding is that drug-resistant virus has low transmission fitness

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