HIV

Background: We estimated the potential number of newly diagnosed HIV infections among adolescent girls and young women (AGYW) using a venue-based approach to HIV testing at sex work hotspots. Methods: We used hotspot enumeration and cross-sectional bio-behavioural survey data from the 2015 Transitions Study of AGYW aged 14-24 years who frequented hotspots in Mombasa, Kenya. We described the HIV cascade among young females who sell sex (YFSS, N=408) versus those who do not (YFNS, N=891); and triangulated the potential (100% test acceptance and accuracy) and feasible (accounting for test acceptance and sensitivity) number of AGYW that could be newly diagnosed via hotspot-based HIV rapid testing in Mombasa. We identified the profile of AGYW with an HIV in the past year using generalized linear mixed regression models. Results: N=37/365 (10.1%) YFSS and N=30/828 (3.6%) NSW were living with HIV, of whom 27.0% (N=10/37) and 30.0% (N=9/30) were diagnosed and aware (p=0.79). Rapid test acceptance was 89.3% and sensitivity was 80.4%. There were an estimated 15,635 (range: 12,172-19,097) AGYW at hotspots. The potential and feasible number of new diagnosis was 627 (310-1,081), and 450 (223-776), respectively. Thus, hotspot-based testing could feasibly reduce the undiagnosed fraction from 71.6% to 20.2%. The profile of AGYW who recently tested was similar among YSW and NSW. YSW were two-fold more likely to report a recent HIV test after adjusting for other determinants [odds ratio (95% CI): 2.2 (1.5-3.1)]. Conclusion: Reaching AGYW via hotspot-based HIV testing could fill gaps left by traditional, clinic-based HIV testing services. Corresponding Author: Sharmistha Mishra, MD, MSc, PhD, MAP-Centre for Urban Health Solutions, St. Michael's Hospital, University of Toronto, 209 Victoria St, Toronto, ON M5B 1T8, E: sharmistha.mishra@utoronto.ca, T: 416-864-5746, Fax: 416-864-5558 The authors have no funding or conflicts of interest to disclose. Funding: The study was supported by the Canadian Institutes of Health Research operating grant MOP-13044 and foundation grant FDN 13455. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Abstract Background Syphilis has been associated with an increase in HIV RNA and a temporary decline in CD4 T cell counts in people living with HIV who are not receiving antiretroviral treatment (ART), and may be associated with a transient HIV RNA rebound in those who are receiving ART. Our case is the first to highlight the risk of a multidrug-resistant HIV viral rebound during the course of early syphilis even if antiretroviral drug concentrations are within the therapeutic range. Case presentation This 50-year-old HIV-1-positive male patient with concomitant early syphilis presented with an HIV RNA rebound (8908 copies/mL) during a scheduled visit to our clinic. He was receiving a stable ART regimen consisting of darunavir/cobicistat plus dolutegravir, and had a 15-year history of viral suppression. Good short-term drug adherence could be inferred as liquid chromatography tandem mass spectrometry showed that his trough antiretroviral drug concentrations were within the therapeutic range: darunavir 2353 ng/mL (minimum effective concentration > 500 ng/mL) and dolutegravir 986 ng/mL (minimum effective concentration > 100 ng/mL). A plasma RNA genotype resistance test revealed wild-type virus in the integrase region and protease region (PR), but extensive resistance in the reverse transcriptase (RT) region (M41L, E44D, D67N, K70R, M184V, L210W and T215Y). Phylogenetic analysis of next-generation sequences (used to investigate the presence of minor viral variants), the PR and RT sequences from plasma HIV RNA and pro-viral DNA extracted from peripheral blood mononuclear cells during the viral rebound, and a Sanger sequence obtained during a previous virological failure suggested clonal viral expression because the previous PR resistance mutations had been lost or had not been archived in pro-viral DNA. Conclusions This case shows that early syphilis may cause an HIV RNA rebound in patients under stable virological control with the potential of transmitting an extensively drug-resistant virus.…

AbstractBackgroundSevere bacterial infections are the first cause of morbidity in people with HIV (PWH). We aimed to assess their incidence and to analyze their determinants.MethodsWe studied HIV-1-infected individuals aged at least 15 years and prospectively followed between 2006 and 2015 in the French Hospital Database on HIV. The Andersen and Gill model was used to calculate the adjusted hazard ratios (HRs), focusing on heavy alcohol use and neutrophil function-altering comorbidities.ResultsOut of 25,795 participants, 1414 developed 1883 severe bacterial infections. Between 2006-2009 and 2013-2015, the incidence fell from 13.2 (95% confidence interval, CI, 12.3-14.1) to 7.1 (95%CI, 6.3-7.8) per 1000 person-years. Heavy alcohol use was associated with an increased risk of severe bacterial infection (HR 1.3, 95% CI 1.1-1.7 for 40-80 g/day and 1.6, 95% CI 1.2-2.1 for > 80 g/day), as were diabetes, chronic kidney disease and end stage liver disease (HR 1.2, 95%CI, 1.0-1.4, when one and 2.3, 95%CI, 1.6-3.4 when more than one comorbidity), and non-AIDS-defining malignancy (HR 2.0, 95%CI: 1.6-2.4).ConclusionsHeavy alcohol use was associated with an increased risk of severe bacterial infection, as were neutrophil function-altering comorbidities. Controlled-drinking approaches should be promoted and comorbidity management should be strengthened in PWH.

AbstractBackgroundCardiovascular and liver disease are main contributors to mortality in people with HIV (PWH). In HIV-uninfected patients, non-alcoholic fatty liver disease (NAFLD) is associated with incident metabolic complications. We investigated the effect of NAFLD on development of metabolic comorbidities in PWH.MethodsWe included PWH undergoing a screening program for NAFLD using transient elastography. NAFLD was defined as controlled attenuation parameter ≥248 dB/m and exclusion of other liver diseases. Incident diabetes, hypertension, dyslipidemia and chronic kidney disease were investigated using survival analysis and Cox proportional hazards.Results485 HIV mono-infected patients were included. During a median follow-up of 40.1 months (interquartile range 26.5-50.7), patients with NAFLD had higher incidence of diabetes (4.74, 95% confidence interval [CI] 3.09-7.27 vs. 0.87, 95% CI 0.42-1.83 per 100 person-years [PY]) and dyslipidemia (8.16, 95% CI 5.42-12.27 vs. 3.99, 95% CI 2.67-5.95 per 100 PY) compared to those without NAFLD. On multivariable analysis, NAFLD was an independent predictor of diabetes (adjusted hazard ratio [aHR] 5.13, 95% CI 2.14-12.31) and dyslipidemia (aHR 2.35, 95% CI 1.34-4.14) development.ConclusionsHIV mono-infected patients with NAFLD are at higher risk of incident diabetes and dyslipidemia. Early referral strategies and timely management of metabolic risk may improve outcomes.

Background: Frailty is an important clinical concern for the aging population of people living with HIV (PLWH). The objective of this study was to identify the combination of risk features that distinguish frail from nonfrail individuals. Setting: Machine learning analysis of highly dimensional risk features was performed on a clinical cohort of PLWH. Methods: Participants included 105 older (average age=55.6) PLWH with at least 3 months of combination antiretroviral therapy (cART; median CD4=546; 70% suppressed). Predictors included demographics, HIV clinical markers, co-morbid health conditions, cognition, and neuroimaging (i.e., volumetrics, resting-state functional connectivity, and cerebral blood flow). Gradient-boosted multivariate regressions (GBM) was implemented to establish linear and interactive classification models. Model performance was determined by sensitivity/specificity (F1 score) with five-fold cross validation. Results: The linear GBM classifier included lower current CD4 count, lower psychomotor performance, and multiple neuroimaging indices (volumes, network connectivity, and blood flow) in visual and motor brain systems (F1 score=71%; precision=84%; sensitivity=66%). The interactive model identified novel synergies between neuroimaging features, female sex, symptoms of depression, and current CD4 count. Conclusions: Data driven algorithms built from highly dimensional clinical and brain imaging features implicates disruption to the visuomotor system in older PLWH designated as frail. Interactions between lower CD4 count, female sex, depressive symptoms and neuroimaging features suggest potentiation of risk mechanisms. Longitudinal data-driven studies are needed to guide clinical strategies capable of preventing the development of frailty as PLWH reach advanced age. Corresponding Author: Robert Paul, Ph.D., University of Missouri, St. Louis, 4633 World Parkway Circle, St. Louis, Missouri, 63141; 314-516-8403; paulro@umsl.edu. Alternate Author: Beau Ances, M.D., Ph.D., Department of Neurology, Campus Box 8111, 660 S. Euclid Avenue, St. Louis, MO 63110; 314-747-8423; bances@wustl.edu Conflicts of Interest and Sources of Funding: The authors have no conflicts of interest to disclose. This work was supported by the National Institutes of Health [R01 NR012657 and R01 NR014449 to B.M.A.]; the National Institute of Mental Health [R01 MH108559 to R.H.P.]; the U.S. Army Medical Research Acquisition Activity [W81XWH-11-2-0174 to R.H.P.]; and the Fogarty International Center of the National Institutes of Health [D43TW009608 to B.T.]. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Journal of Medical Virology, Accepted Article.

AbstractBackgroundAs part of the Household Influenza Vaccine Evaluation (HIVE) study, acute respiratory infections (ARI) have been identified in children and adults over 8 years.MethodsAnnually, 890 to 1441 individuals were followed and contacted weekly to report ARIs. Specimens collected during illness were tested for human coronaviruses (HCoV) types OC43, 229E, HKU1, and NL63.ResultsIn total, 993 HCoV infections were identified over 8 years, with OC43 most commonly seen and 229E the least. HCoVs were detected in a limited time period, between December and April/May, and peaked in January/February. Highest infection frequency was in children

Nature Medicine, Published online: 02 April 2020; doi:10.1038/s41591-020-0837-0A trial of a therapeutic vaccine against HIV induces cellular immunity and, although it provides hope, it highlights the hurdles for the development of such strategies.

The development of rapid and accurate diagnostic tests for tuberculosis (TB), which decreases the time of treatment initiation is an important strategy to control the TB epidemic. The WHO recommended Xpert MTB/RIF assay (Cepheid, USA) is an automated cartridge-based, real-time polymerase chain reaction (PCR) assay that has been proven to reduce time to treatment initiation in TB patients (Boehme et al., 2011, Calligaro et al., 2017) by detecting the presence of TB and drug resistance to rifampicin (RIFR) in sputum samples within 2 hrs (Theron et al., 2011).

Background: Several antiretroviral therapy (ART) classes have been associated with increased myocardial infarction (MI) risk. Cardiovascular disease (CVD) in people living with HIV (PLWH) on integrase strand transfer inhibitors (INSTI) has not been examined. Here we aim to examine this. Setting: Retrospective cohort design study Methods: We used the IBM®MarketScan® databases for U.S. commercially insured and Medicaid covered adults to identify PLWH newly initiated on ART between Jan 1, 2008 and Dec 30, 2015. Major adverse cardiac event (MACE), a composite of acute MI, ischemic stroke, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), was the primary outcome. We used calendar-time specific probability-weighted Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between INSTI use and MACE. We used propensity score weighting methods to account for potential confounding. Results: 20,242 new ART initiators were identified. 5,069 (25%) PLWH initiated INSTI-based regimens. 203 MACE events occurred; acute MI 16 (0.32%) vs 66 (0.43%), stroke 24 (0.47%) vs 54 (0.36), CABG 2 (0.04%) vs 9 (0.06%), PCI 7 (0.14%) vs 25 (0.16%) of INSTI users vs non-users. INSTI-based ART was associated with significantly lower risk of MACE events (HR 0.79; 95% CI 0.64, 0.96) compared to non-INSTI-based regimens. Conclusion: In this cohort, INSTI-based regimens were associated with a 21% decreased risk of incident CVD. These finding require validation in other cohorts and with longer follow up. Corresponding author: Jane O’Halloran, Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, 4523 Clayton Ave, Campus Box 8051, St. Louis, MO 63110, Telephone: 314-454-8354, Fax: 314-454-8687, Email: janeaohalloran@wustl.edu Conflicts of Interest and Source of Funding: This work was supported by an unrestricted institutional grant from Merck & Co. AMB is supported in part by a grant from the National Center for Advancing Translational Sciences (NCATS), NIH under award number KL2 TR002346. The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ). WGP reports grants and personal fees from Merck and Co, and personal fees from Gilead Sciences. MAO reports grants and personal fees from Pfizer, and grants from Sanofi. JAO, JS and AMB report no conflicts. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Background: Non-alcoholic fatty liver disease (NAFLD) and human immunodeficiency virus (HIV) are independently associated with cardiovascular disease (CVD). However, the factors associated with NAFLD in persons living with HIV (PWH) and whether CVD is more frequent in PWH with NAFLD are currently unknown. Methods: From the Partners HealthCare Research Patient Data Registry, we identified PWH with and without NAFLD between 2010-2017. NAFLD was defined using validated histological or radiographic criteria. CVD was defined by an ICD-9 diagnosis of coronary artery disease, myocardial infarction, coronary revascularization, peripheral vascular disease, heart failure, transient ischemic attack, or stroke and was confirmed by clinician review. Multivariable logistic regression was performed to examine the relationship between NAFLD and CVD. Results: Compared with PWH without NAFLD (n=135), PWH with NAFLD (n=97) had higher body mass index and more frequently had hypertension, obstructive sleep apnea, diabetes mellitus, dyslipidemia, coronary artery disease, and CVD (p

Background: Interpersonal trauma (IPT) is highly prevalent among HIV-positive (HIV+) individuals but its relationship with brain morphology and function is poorly understood. Setting: This cross-sectional analysis evaluated the associations of IPT with cognitive task performance, daily functioning, MRI brain cortical thickness and bilateral volumes of four selected basal ganglia (BG) regions in a US-based cohort of aviremic HIV+ individuals, with (HIV+IPT+) and without IPT exposure (HIV+IPT-), and socio-demographically matched HIV-negative controls with (HIV-IPT+) and without IPT exposure (HIV-IPT-). Methods: Enrollees completed brain MRI scans, a semi-structured psychiatric interview, a neurocognitive battery, and three measures of daily functioning. Demographic and clinical characteristics of the four groups were described, and pairwise between-group comparisons performed using chi-square tests, ANOVA, or t-tests. Linear or Poisson regressions evaluated relationships between group status and the outcomes of interest, in 6 pairwise comparisons, using Bonferroni correction for statistical significance. Results: Among 187 participants (mean age 50.0 years, 63% male, 64% non-White), 102 were HIV+IPT+, 35 HIV+IPT-, 26 HIV-IPT-, and 24 were HIV-IPT+. Compared to the remaining three groups, the HIV+IPT+ group had more Activities of Daily Living declines, higher number of impaired Patient’s Assessment of Own Functioning Inventory scores, and lower cortical thickness in multiple cerebral regions. Attention/working memory test performances were significantly better in HIV-IPT- compared to HIV+IPT+ and HIV+IPT- groups. BG MRI volumes were not significantly different in any between-group comparisons. Conclusion: IPT exposure and HIV infection have a synergistic effect on daily functioning and cortical thickness in aviremic HIV+ individuals. Corresponding author: Suad Kapetanovic, MD, kapetano@usc.edu, USC Keck School of Medicine, Department of Psychiatry and the Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, Telephone: 323-442-6000, Fax: 323-442-6001 The authors report no conflicts of interest related to this work. Disclaimers: All authors contributed to this article as part of their official duties. This research was supported by the Intramural Research Training Award program at the National Institutes of Health; by the Division of Intramural Research of the National Institute of Neurological Disorders and Stroke; by the Division of Intramural Research Programs of the National Institute of Mental Health; the authors have no relevant financial or non-financial relationships to disclose. This project has been funded in whole or in part with federal funds from the NIH Office of AIDS Research. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. Previous Presentation: An abstract reporting parts of this data was presented at the 63rd Annual Meeting of the Academy of Consultation-Liaison Psychiatry, San Diego, California, November 16, 2019 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Abstract. Schistosomiasis is an acute and chronic parasitic disease caused by blood flukes of the genus Schistosoma. More than 220 million people worldwide were estimated to have active schistosomiasis in 2017, 90% of whom live on the African continent, but only 102 million were reported to have received treatment. Africa is also disproportionately burdened by HIV, with an estimated 26 million people living with HIV in 2017. Given these overlapping epidemics, we conducted a systematic review to ascertain the contribution of schistosomes to HIV acquisition risk, the contribution of HIV to schistosome acquisition, the impact of HIV on schistosomiasis-related morbidity, the impact of schistosomes on HIV disease progression and immune response, the impact of HIV on the efficacy of praziquantel treatment, and the impact of HIV on egg shedding. We reviewed studies of people living in sub-Saharan Africa coinfected with HIV and Schistosoma spp. between January 1996 and July 2018. We found that 1) infection with Schistosoma haematobium increases the risk of HIV acquisition, 2) there is currently a lack of data on whether HIV infection increases the risk of Schistosoma acquisition, 3a) HIV coinfection was not an accelerating factor for adverse Schistosoma outcomes, 3b) schistosomiasis may be an important contributor to immune activation in HIV coinfected people, 4) praziquantel use in coinfected people may improve immune reconstitution on antiretroviral therapy for HIV, and 5) there is evidence that HIV infection reduces egg excretion in individuals infected with Schistosoma mansoni.…

In a setting with a high burden of previous tuberculosis, Ultra generated more non-actionable results and had diminished specificity compared with Xpert. In patients with recent previous tuberculosis, a quarter of Ultra-positive samples were indeterminate for rifampicin resistance and culture negative, suggesting that additional drug-resistance testing will probably be unsuccessful. Our data have implications for the handling of Ultra-positive results in patients with previous tuberculosis in high burden settings.

Globally, mother to child transmission of HIV attributed for 20% of all HIV infections (Workagegn et al., 2015). There were 170,000 new HIV infected children in 2014 worldwide after a rapid droping of mother to child transmission of HIV between 2009 and 2014. The prevalence decreased by 48% (UNAIDs, 2015). In the absence of intervention to prevent HIV, the prevalence of MTCT estimated to be 25 to 45% (Ethiopian Federal HIV/AIDS Prevention and Control Office, 2011; Global HIV/AIDS, 2020). Ethiopia had a high prevalence of MTCT of HIV (Parker et al., 2015).

AbstractThe majority of cells with latent HIV-1 infection is located in lymphoid tissues that are difficult to access. Here we used single-genome near full-length proviral sequencing to evaluate intact and defective proviruses in blood and lymph node CD4 T cells enriched for specific functional polarizations. We observed minor variations between the frequencies of proviral sequences within individual CD4 T cell subsets and across tissue compartments. Yet, we noted multiple clonal clusters of identical intact or defective proviral sequences from distinct compartments and CD4 T cell subpopulations, suggesting frequent interchanges between viral reservoir cells in blood and tissues.

AbstractHIV-2 infection is endemic in some countries in West Africa. Due to the lower prevalence in industrialized countries, there is limited experience and knowledge on management of HIV-2 infected individuals in Europe. Compared to HIV-1, there are differential characteristics of HIV-2 regarding diagnostic procedures, clinical course and, most importantly, antiretroviral therapy.We integrated the published literature on HIV-2 (studies and reports on epidemiology, diagnostics, clinical course, treatment) as well as expert experience in diagnosing and clinical care of HIV-2 infected to provide recommendations for a present standard of medical care of HIV- infected in Western European countries, including an overview of strategies for diagnosis, monitoring and treatment, with suggestions for effective drug combinations for first- and second line treatment, post-exposure prophylaxis and prevention of mother-to-child transmission as well as listings of mutations related to HIV-2 drug resistance- and CCR5/CRCX4 co-receptor tropism.

AbstractIntroductionProgrammatic treatment outcome data for people living with HIV-2 in West Africa, where the virus is most prevalent, are scarce.MethodsHIV-2-infected adults initiating or receiving ART through the Senegalese national AIDS program were invited to participate in this prospective, longitudinal observational cohort study. We analyzed HIV-2 viral loads, CD4 counts, antiretroviral drug resistance, loss to follow up, and mortality. We also examined changes in treatment guidelines over time and assessed progress toward UNAIDS’ 90-90-90 targets for HIV-2.ResultsWe enrolled 291 participants at two sites for 926.0 person-years of follow-up over 13 years. Median follow-up time was 2.2 years per participant. There were 21 deaths reported (7.2%), and 117 individuals (40.2%) were lost to follow-up, including 43 (14.7%) who had an initial visit but never returned for follow-up. CD4 counts and HIV-2 viral suppression (

The biologic Griffithsin (GRFT) has recently emerged as a candidate to safely prevent sexually transmitted infections (STIs) including human immunodeficiency virus (HIV-1) and herpes simplex virus 2 (HSV-2). However, to date, there are few delivery platforms that are available to effectively deliver biologics to the female reproductive tract (FRT). The goal of this work was to evaluate rapid-release polyethylene oxide (PEO), polyvinyl alcohol (PVA) and polyvinylpyrrolidone (PVP) fibers, that incorporate GRFT, in in vitro (HIV-1 and HSV-2) and in vivo (HSV-2) infection models. GRFT loading was determined via ELISA, and the bioactivity of GRFT fibers was assessed using in vitro HIV-1 pseudovirus and HSV-2 plaque assays. Afterwards, the efficacy of GRFT fibers was assessed in a murine model of lethal HSV-2 infection. Finally, murine reproductive tracts and vaginal lavages were evaluated for histology and cytokine expression, 24 and 72 hr after fiber administration, to determine safety. All rapid-release formulations achieved high levels of GRFT incorporation and were completely efficacious against in vitro HIV-1 and HSV-2 infections. Importantly, all rapid-release GRFT fibers provided potent protection in a murine model of HSV-2 infection. Moreover, histology and cytokine levels, evaluated from collected murine reproductive tissues and vaginal lavages treated with blank fibers, showed no increased cytokine production or histological aberrations, demonstrating the preliminary safety of rapid-release GRFT fibers in vaginal tissue.…

Randomized-trial data on the risks and benefits of antiretroviral therapy (ART) as compared with zidovudine and single-dose nevirapine to prevent transmission of the human immunodeficiency virus (HIV) in HIV-infected pregnant women with high CD4 counts are lacking.

Data from randomized trials are lacking on the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic human immunodeficiency virus (HIV) infection who have a CD4+ count of more than 350 cells per cubic millimeter.

Progressive immune dysfunction and the acquired immunodeficiency syndrome (AIDS) develop in most persons with untreated infection with human immunodeficiency virus type 1 (HIV-1) but in only approximately 20 to 30% of persons infected with HIV type 2 (HIV-2); among persons infected with both types, the natural history of disease progression is poorly understood.

Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations.

The optimal time for the initiation of antiretroviral therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection is uncertain.

There is considerable genetic diversity among viruses of different subtypes (designated A to J) in the major group of human immunodeficiency virus type 1 (HIV-1), the form of HIV that is dominant in the global epidemic. If available, HIV-1 sequences pre-dating the recognition of AIDS could be crucial in defining the time of origin and the subsequent evolution of these viruses in humans. The oldest known case of HIV-1 infection was reported to be that of a sailor from Manchester who died of an AIDS-like illness in 1959; however, the authenticity of this case has not been confirmed. Genetic analysis of sequences from clinical materials obtained from 1971 to 1976 from members of a Norwegian family infected earlier than 1971 showed that they carried viruses of the HIV-1 outlier group, a variant form that is mainly restricted to West Africa. Here we report the amplification and characterization of viral sequences from a 1959 African plasma sample that was previously found to be HIV-1 seropositive. Multiple phylogenetic analyses not only authenticate this case as the oldest known HIV-1 infection, but also place its viral sequence near the ancestral node of subtypes B and D in the major group, indicating that these HIV-1 subtypes, and perhaps all major-group viruses, may have evolved from a single introduction into the African population not long before 1959.