A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transm... Mehr ...

Verfasser: Wymant, Chris
Bezemer, Daniela
Blanquart, François
Ferretti, Luca
Gall, Astrid
Hall, Matthew
Golubchik, Tanya
Bakker, Margreet
Ong, Swee Hoe
Zhao, Lele
Bonsall, David
de Cesare, Mariateresa
MacIntyre-Cockett, George
Abeler-Dörner, Lucie
Albert, Jan
Bannert, Norbert
Fellay, Jacques
Grabowski, M Kate
Gunsenheimer-Bartmeyer, Barbara
Günthard, Huldrych F
Kivelä, Pia
Kouyos, Roger D
Laeyendecker, Oliver
Meyer, Laurence
Porter, Kholoud
Ristola, Matti
van Sighem, Ard
Berkhout, Ben
Kellam, Paul
Cornelissen, Marion
Reiss, Peter
Fraser, Christophe
Aubert, V
Battegay, M
Bernasconi, E
Böni, J
Braun, D L
Bucher, H C
Burton-Jeangros, C
Calmy, A
Cavassini, M
Dollenmaier, G
Egger, M
Elzi, L
Fehr, J
Fellay, J
Furrer, H
Fux, C A
Gorgievski, M
Günthard, H
Haerry, D
Hasse, B
Hirsch, H H
Hoffmann, M
Hösli, I
Kahlert, C
Kaiser, L
Keiser, O
Klimkait, T
Kouyos, R
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Ledergerber, B
Martinetti, G
de Tejada, B Martinez
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Hillenbrand, Heribert
Schlote, Frank
Lauenroth-Mai, Elke
Schuler, Christoph
Schürmann, Dirk
Wesselmann, Hans
Brockmeyer, Norbert
Gehring, Peter
Schmalöer, Dirk
Hower, Martin
Spornraft-Ragaller, Petra
Häussinger, Dieter
Reuter, Stefan
Esser, Stefan
Markus, Rudolf
Kreft, Burkhard
Berzow, Dirk
Christl, Andreas
Meyer, Andreas
Plettenberg, Andreas
Stoehr, Albrecht
Graefe, Katrin
Lorenzen, Thore
Adam, Axel
Schewe, Knut
Weitner, Lutwin
Fenske, Stefan
Hansen, Stefan
Stellbrink, Hans-Jürgen
Wiemer, Dorothea
Hertling, Sandra
Schmidt, Reinhold
Arbter, Peter
Claus, Bernd
Galle, Peter
Jäger, Hans
Jä Gel-Guedes, Eva
Postel, Nils
Fröschl, Monika
Spinner, Christoph
Bogner, Johannes
Salzberger, Bernd
Schölmerich, Jürgen
Audebert, Franz
Marquardt, Ties
Schaffert, Andreas
Schnaitmann, Eiko
Trein, Andreas
Frietsch, Bernhard
Müller, Marcus
Ulmer, Albrecht
Detering-Hübner, Barbara
Kern, Peter
Schubert, Franz
Dehn, Günther
Schreiber, Maria
Güler, Cengiz
Schmidt, Daniel
Meixenberger, Karolin
Dokumenttyp: Artikel
Erscheinungsdatum: 2022
Reihe/Periodikum: Wymant , C , Bezemer , D , Blanquart , F , Ferretti , L , Gall , A , Hall , M , Golubchik , T , Bakker , M , Ong , S H , Zhao , L , Bonsall , D , de Cesare , M , MacIntyre-Cockett , G , Abeler-Dörner , L , Albert , J , Bannert , N , Fellay , J , Grabowski , M K , Gunsenheimer-Bartmeyer , B , Günthard , H F , Kivelä , P , Kouyos , R D , Laeyendecker , O , Meyer , L , Porter , K , Ristola , M , van Sighem , A , Berkhout , B , Kellam , P , Cornelissen , M , Reiss , P , Fraser , C , Aubert , V , Battegay , M , Bernasconi , E , Böni , J , Braun , D L , Bucher , H C , Burton-Jeangros , C , Calmy , A , Cavassini , M , Dollenmaier , G , Egger , M , Elzi , L , Fehr , J , Fellay , J , Furrer , H , Fux , C A , Gorgievski , M , Günthard , H , Haerry , D , Hasse , B , Hirsch , H H , Hoffmann , M , Hösli , I , Kahlert , C , Kaiser , L , Keiser , O , Klimkait , T , Kouyos , R , Kovari , H , Ledergerber , B , Martinetti , G , de Tejada , B M , Marzolini , C , Metzner , K , Müller , N , Nadal , D , Nicca , D , Pantaleo , G , Rauch , A , Regenass , S , Rudin , C , Schöni-Affolter , F , Schmid , P , Speck , R , Stöckle , M , Tarr , P , Trkola , A , Vernazza , P , Weber , R , Yerly , S , van der Valk , M , Geerlings , S E , Goorhuis , A , Hovius , J W , Lempkes , B , Nellen , F J B , van der Poll , T , Prins , J M , Reiss , P , van Vugt , M , Wiersinga , W J , Wit , F W M N , van Duinen , M , van Eden , J , Hazenberg , A , van Hes , A M H , Pijnappel , F J J , Smalhout , S Y , Weijsenfeld , A M , Jurriaans , S , Back , N K T , Zaaijer , H L , Berkhout , B , Cornelissen , M T E , Schinkel , C J , Wolthers , K C , Peters , E J G , van Agtmael , M A , Autar , R S , Bomers , M , Sigaloff , K C E , Heitmuller , M , Laan , L M , Ang , C W , van Houdt , R , Jonges , M , Kuijpers , T W , Pajkrt , D , Scherpbier , H J , de Boer , C , van der Plas , A , van den Berge , M , Stegeman , A , Baas , S , Hage de Looff , L , Buiting , A , Reuwer , A , Veenemans , J , Wintermans , B , Pronk , M J H , Ammerlaan , H S M , van den Bersselaar , D N J , de Munnik , E S , Deiman , B , Jansz , A R , Scharnhorst , V , Tjhie , J , Wegdam , M C A , van Eeden , A , Nellen , J , Brokking , W , Elsenburg , L J M , Nobel , H , van Kasteren , M E E , Berrevoets , M A H , Brouwer , A E , Adams , A , van Erve , R , de Kruijf-van de Wiel , B A F M , Keelan-Phaf , S , van der Ven , B , van der Ven , B , Buiting , A G M , Murck , J L , de Vries-Sluijs , T E M S , Bax , H I , van Gorp , E C M , de Jong-Peltenburg , N C , de Mendonç A Melo , M , van Nood , E , Nouwen , J L , Rijnders , B J A , Rokx , C , Schurink , C A M , Slobbe , L , Verbon , A , Bassant , N , van Beek , J E A , Vriesde , M , van Zonneveld , L M , de Groot , J , Boucher , C A B , Koopmans , M P G , van Kampen , J J A , Fraaij , P L A , van Rossum , A M C , Vermont , C L , van der Knaap , L C , Visser , E , Branger , J , Douma , R A , Cents-Bosma , A S , Duijf-van de Ven , C J H M , Schippers , E F , van Nieuwkoop , C , van Ijperen , J M , Geilings , J , van der Hut , G , van Burgel , N D , Leyten , E M S , Gelinck , L B S , Mollema , F , Davids-Veldhuis , S , Tearno , C , Wildenbeest , G S , Heikens , E , Groeneveld , P H P , Bouwhuis , J W , Lammers , A J J , Kraan , S , van Hulzen , A G W , Kruiper , M S M , van der Bliek , G L , Bor , P C J , Debast , S B , Wagenvoort , G H J , Kroon , F P , de Boer , M G J , Jolink , H , Lambregts , M M C , Roukens , A H E , Scheper , H , Dorama , W , van Holten , N , Claas , E C J , Wessels , E , den Hollander , J G , El Moussaoui , R , Pogany , K , Brouwer , A E , Smit , J V , Struik-Kalkman , D , van Niekerk , T , Pontesilli , O , Lowe , S H , Oude Lashof , A M L , Posthouwer , D , van Wolfswinkel , M E , Ackens , R P , Burgers , K , Schippers , J , Weijenberg-Maes , B , van Loo , I H M , Havenith , T R A , van Vonderen , M G A , Kampschreur , L M , Faber , S , Steeman-Bouma , R , Al Moujahid , A , Kootstra , G J , Delsing , C E , van der Burg-van de Plas , M , Scheiberlich , L , Kortmann , W , van Twillert , G , Renckens , R , Ruiter-Pronk , D , van Truijen-Oud , F A , Cohen Stuart , J W T , Jansen , E R , Hoogewerf , M , Rozemeijer , W , van der Reijden , W A , Sinnige , J C , Brinkman , K , van den Berk , G E L , Blok , W L , Lettinga , K D , de Regt , M , Schouten , W E M , Stalenhoef , J E , Veenstra , J , Vrouenraets , S M E , Blaauw , H , Geerders , G F , Kleene , M J , Kok , M , Knapen , M , van der Meché , I B , Mulder-Seeleman , E , Toonen , A J M , Wijnands , S , Wttewaal , E , Kwa , D , van Crevel , R , van Aerde , K , Dofferhoff , A S M , Henriet , S S V , Ter Hofstede , H J M , Hoogerwerf , J , Keuter , M , Richel , O , Albers , M , Grintjes-Huisman , K J T , de Haan , M , Marneef , M , Strik-Albers , R , Rahamat-Langendoen , J , Stelma , F F , Burger , D , Gisolf , E H , Hassing , R J , Claassen , M , Ter Beest , G , van Bentum , P H M , Langebeek , N , Tiemessen , R , Swanink , C M A , van Lelyveld , S F L , Soetekouw , R , van der Prijt , L M M , van der Swaluw , J , Bermon , N , van der Reijden , W A , Jansen , R , Herpers , B L , Veenendaal , D , Verhagen , D W M , Lauw , F N , van Broekhuizen , M C , van Wijk , M , Bierman , W F W , Bakker , M , Kleinnijenhuis , J , Kloeze , E , Middel , A , Postma , D F , Schölvinck , E H , Stienstra , Y , Verhage , A R , Wouthuyzen-Bakker , M , Boonstra , A , de Groot-de Jonge , H , van der Meulen , P A , de Weerd , D A , Niesters , H G M , van Leer-Buter , C C , Knoester , M , Hoepelman , A I M , Arends , J E , Barth , R E , Bruns , A H W , Ellerbroek , P M , Mudrikova , T , Oosterheert , J J , Schadd , E M , van Welzen , B J , Aarsman , K , Griffioen-van Santen , B M G , de Kroon , I , van Berkel , M , van Rooijen , C S A M , Schuurman , R , Verduyn-Lunel , F , Wensing , A M J , Bont , L J , Geelen , S P M , Loeffen , Y G T , Wolfs , T F W , Nauta , N , Rooijakkers , E O W , Holtsema , H , Voigt , R , van de Wetering , D , Alberto , A , van der Meer , I , Rosingh , A , Halaby , T , Zaheri , S , Boyd , A C , Bezemer , D O , van Sighem , A I , Smit , C , Hillebregt , M , de Jong , A , Woudstra , T , Bergsma , D , Meijering , R , van de Sande , L , Rutkens , T , van der Vliet , S , de Groot , L , van den Akker , M , Bakker , Y , El Berkaoui , A , Bezemer , M , Brétin , N , Djoechro , E , Groters , M , Kruijne , E , Lelivelt , K J , Lodewijk , C , Lucas , E , Munjishvili , L , Paling , F , Peeck , B , Ree , C , Regtop , R , Ruijs , Y , Schoorl , M , Schnörr , P , Scheigrond , A , Tuijn , E , Veenenberg , L , Visser , K M , Witte , E C , Ruijs , Y , Van Frankenhuijsen , M , Allegre , T , Makhloufi , D , Livrozet , J-M , Chiarello , P , Godinot , M , Brunel-Dalmas , F , Gibert , S , Trepo , C , Peyramond , D , Miailhes , P , Koffi , J , Thoirain , V , Brochier , C , Baudry , T , Pailhes , S , Lafeuillade , A , Philip , G , Hittinger , G , Assi , A , Lambry , V , Rosenthal , E , Naqvi , A , Dunais , B , Cua , E , Pradier , C , Durant , J , Joulie , A , Quinsat , D , Tempesta , S , Ravaux , I , Martin , I P , Faucher , O , Cloarec , N , Champagne , H , Pichancourt , G , Morlat , P , Pistone , T , Bonnet , F , Mercie , P , Faure , I , Hessamfar , M , Malvy , D , Lacoste , D , Pertusa , M-C , Vandenhende , M-A , Bernard , N , Paccalin , F , Martell , C , Roger-Schmelz , J , Receveur , M-C , Duffau , P , Dondia , D , Ribeiro , E , Caltado , S , Neau , D , Dupont , M , Dutronc , H , Dauchy , F , Cazanave , C , Vareil , M-O , Wirth , G , Le Puil , S , Pellegrin , J-L , Raymond , I , Viallard , J-F , Chaigne de Lalande , S , Garipuy , D , Delobel , P , Obadia , M , Cuzin , L , Alvarez , M , Biezunski , N , Porte , L , Massip , P , Debard , A , Balsarin , F , Lagarrigue , M , Prevoteau du Clary , F , Aquilina , C , Reynes , J , Baillat , V , Merle , C , Lemoing , V , Atoui , N , Makinson , A , Jacquet , J M , Psomas , C , Tramoni , C , Aumaitre , H , Saada , M , Medus , M , Malet , M , Eden , A , Neuville , S , Ferreyra , M , Sotto , A , Barbuat , C , Rouanet , I , Leureillard , D , Mauboussin , J-M , Lechiche , C , Donsesco , R , Cabie , A , Abel , S , Pierre-Francois , S , Batala , A-S , Cerland , C , Rangom , C , Theresine , N , Hoen , B , Lamaury , I , Fabre , I , Schepers , K , Curlier , E , Ouissa , R , Gaud , C , Ricaud , C , Rodet , R , Wartel , G , Sautron , C , Beck-Wirth , G , Michel , C , Beck , C , Halna , J-M , Kowalczyk , J , Benomar , M , Drobacheff-Thiebaut , C , Chirouze , C , Faucher , J-F , Parcelier , F , Foltzer , A , Haffner-Mauvais , C , Hustache Mathieu , M , Proust , A , Piroth , L , Chavanet , P , Duong , M , Buisson , M , Waldner , A , Mahy , S , Gohier , S , Croisier , D , May , T , Delestan , M , Andre , M , Zadeh , M M , Martinot , M , Rosolen , B , Pachart , A , Martha , B , Jeunet , N , Rey , D , Cheneau , C , Partisani , M , Priester , M , Bernard-Henry , C , Batard , M-L , Fischer , P , Berger , J-L , Kmiec , I , Robineau , O , Huleux , T , Ajana , F , Alcaraz , I , Allienne , C , Baclet , V , Meybeck , A , Valette , M , Viget , N , Aissi , E , Biekre , R , Cornavin , P , Merrien , D , Seghezzi , J-C , Machado , M , Diab , G , Raffi , F , Bonnet , B , Allavena , C , Grossi , O , Reliquet , V , Billaud , E , Brunet , C , Bouchez , S , Morineau-Le Houssine , P , Sauser , F , Boutoille , D , Besnier , M , Hue , H , Hall , N , Brosseau , D , Souala , F , Michelet , C , Tattevin , P , Arvieux , C , Revest , M , Leroy , H , Chapplain , J-M , Dupont , M , Fily , F , Patra-Delo , S , Lefeuvre , C , Bernard , L , Bastides , F , Nau , P , Verdon , R , de la Blanchardiere , A , Martin , A , Feret , P , Geffray , L , Daniel , C , Rohan , J , Fialaire , P , Chennebault , J M , Rabier , V , Abgueguen , P , Rehaiem , S , Luycx , O , Niault , M , Moreau , P , Poinsignon , Y , Goussef , M , Mouton-Rioux , V , Houlbert , D , Alvarez-Huve , S , Barbe , F , Haret , S , Perre , P , Leantez-Nainville , S , Esnault , J-L , Guimard , T , Suaud , I , Girard , J-J , Simonet , V , Debab , Y , Schmit , J-L , Jacomet , C , Weinberck , P , Genet , C , Pinet , P , Ducroix , S , Durox , H , Denes , É , Abraham , B , Gourdon , F , Antoniotti , O , Molina , J-M , Ferret , S , Lascoux-Combe , C , Lafaurie , M , Colin de Verdiere , N , Ponscarme , D , De Castro , N , Aslan , A , Rozenbaum , W , Pintado , C , Clavel , F , Taulera , O , Gatey , C , Munier , A-L , Gazaigne , S , Penot , P , Conort , G , Lerolle , N , Leplatois , A , Balausine , S , Delgado , J , Timsit , J , Tabet , M , Gerard , L , Girard , P-M , Picard , O , Tredup , J , Bollens , D , Valin , N , Campa , P , Bottero , J , Lefebvre , B , Tourneur , M , Fonquernie , L , Wemmert , C , Lagneau , J-L , Yazdanpanah , Y , Phung , B , Pinto , A , Vallois , D , Cabras , O , Louni , F , Pialoux , G , Lyavanc , T , Berrebi , V , Chas , J , Lenagat , S , Rami , A , Diemer , M , Parrinello , M , Depond , A , Salmon , D , Guillevin , L , Tahi , T , Belarbi , L , Loulergue , P , Zak Dit Zbar , O , Launay , O , Silbermann , B , Leport , C , Alagna , L , Pietri , M-P , Simon , A , Bonmarchand , M , Amirat , N , Pichon , F , Kirstetter , M , Katlama , C , Valantin , M A , Tubiana , R , Caby , F , Schneider , L , Ktorza , N , Calin , R , Merlet , A , Ben Abdallah , S , Weiss , L , Buisson , M , Batisse , D , Karmochine , M , Pavie , J , Minozzi , C , Jayle , D , Castel , P , Derouineau , J , Kousignan , P , Eliazevitch , M , Pierre , I , Collias , L , Viard , J-P , Gilquin , J , Sobel , A , Slama , L , Ghosn , J , Hadacek , B , Thu-Huyn , N , Nait-Ighil , L , Cros , A , Maignan , A , Duvivier , C , Consigny , P H , Lanternier , F , Shoai-Tehrani , M , Touam , F , Jerbi , S , Bodard , L , Jung , C , Goujard , C , Quertainmont , Y , Duracinsky , M , Segeral , O , Blanc , A , Peretti , D , Cheret , A , Chantalat , C , Dulucq , M J , Levy , Y , Lelievre , J D , Lascaux , A S , Dumont , C , Boue , F , Chambrin , V , Abgrall , S , Kansau , I , Raho-Moussa , M , De Truchis , P , Dinh , A , Davido , B , Marigot , D , Berthe , H , Devidas , A , Chevojon , P , Chabrol , A , Agher , N , Lemercier , Y , Chaix , F , Turpault , I , Bouchaud , O , Honore , P , Rouveix , E , Reimann , E , Belan , A G , Godin Collet , C , Souak , S , Mortier , E , Bloch , M , Simonpoli , A-M , Manceron , V , Cahitte , I , Hiraux , E , Lafon , E , Cordonnier , F , Zeng , A-F , Zucman , D , Majerholc , C , Bornarel , D , Uludag , A , Gellen-Dautremer , J , Lefort , A , Bazin , C , Daneluzzi , V , Gerbe , J , Jeantils , V , Coupard , M , Patey , O , Bantsimba , J , Delllion , S , Paz , P C , Cazenave , B , Richier , L , Garrait , V , Delacroix , I , Elharrar , B , Vittecoq , D , Bolliot , C , Lepretre , A , Genet , P , Masse , V , Perrone , V , Boussard , J-L , Chardon , P , Froguel , E , Simon , P , Tassi , S , Avettand Fenoel , V , Barin , F , Bourgeois , C , Cardon , F , Chaix , M-L , Delfraissy , J F , Essat , A , Fischer , H , Lecuroux , C , Meyer , L , Petrov-Sanchez , V , Rouzioux , C , Saez-Cirion , A , Seng , R , Kuldanek , K , Mullaney , S , Young , C , Zucchetti , A , Bevan , M-A , McKernan , S , Wandolo , E , Richardson , C , Youssef , E , Green , P , Faulkner , S , Faville , R , Herman , S , Care , C , Blackman , H , Bellenger , K , Fairbrother , K , Phillips , A , Babiker , A , Delpech , V , Fidler , S , Clarke , M , Fox , J , Gilson , R , Goldberg , D , Hawkins , D , Johnson , A , Johnson , M , McLean , K , Nastouli , E , Post , F , Kennedy , N , Pritchard , J , Andrady , U , Rajda , N , Donnelly , C , McKernan , S , Drake , S , Gilleran , G , White , D , Ross , J , Harding , J , Faville , R , Sweeney , J , Flegg , P , Toomer , S , Wilding , H , Woodward , R , Dean , G , Richardson , C , Perry , N , Gompels , M , Jennings , L , Bansaal , D , Browing , M , Connolly , L , Stanley , B , Estreich , S , Magdy , A , O'Mahony , C , Fraser , P , Jebakumar , S P R , David , L , Mette , R , Summerfield , H , Evans , M , White , C , Robertson , R , Lean , C , Morris , S , Winter , A , Faulkner , S , 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Young , S , Rooney , G , Snart , B , Currie , J , Fitzgerald , M , Arumainayyagam , J , Chandramani , S , Rajamanoharan , S , Robinson , T , Taylor , B , Brewer , C , Mayr , C , Schmidt , W , Speidel , A , Strohbach , F , Arastéh , K , Cordes , C , Stündel , M , Claus , J , Baumgarten , A , Carganico , A , Ingiliz , P , Dupke , S , Freiwald , M , Rausch , M , Moll , A , Schleehauf , D , Hintsche , B , Klausen , G , Jessen , H , Jessen , A , Köppe , S , Kreckel , P , Schranz , D , Fischer , K , Schulbin , H , Speer , M , Glaunsinger , T , Wicke , T , Bieniek , B , Hillenbrand , H , Schlote , F , Lauenroth-Mai , E , Schuler , C , Schürmann , D , Wesselmann , H , Brockmeyer , N , Gehring , P , Schmalöer , D , Hower , M , Spornraft-Ragaller , P , Häussinger , D , Reuter , S , Esser , S , Markus , R , Kreft , B , Berzow , D , Christl , A , Meyer , A , Plettenberg , A , Stoehr , A , Graefe , K , Lorenzen , T , Adam , A , Schewe , K , Weitner , L , Fenske , S , Hansen , S , Stellbrink , H-J , Wiemer , D , Hertling , S , Schmidt , R , Arbter , P , Claus , B , Galle , P , Jäger , H , Jä Gel-Guedes , E , Postel , N , Fröschl , M , Spinner , C , Bogner , J , Salzberger , B , Schölmerich , J , Audebert , F , Marquardt , T , Schaffert , A , Schnaitmann , E , Trein , A , Frietsch , B , Müller , M , Ulmer , A , Detering-Hübner , B , Kern , P , Schubert , F , Dehn , G , Schreiber , M , Güler , C , Gunsenheimer-Bartmeyer , B , Schmidt , D , Meixenberger , K , Bannert , N & Netherlands ATHENA HIV Observational Cohort† 2022 , ' A highly virulent variant of HIV-1 circulating in the Netherlands ' , Science , vol. 375 , no. 6580 , A30 , pp. 540-545 . https://doi.org/10.1126/science.abk1688
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-29216333
Datenquelle: BASE; Originalkatalog
Powered By: BASE
Link(s) : https://research.vumc.nl/en/publications/b1227ff3-359f-455e-bf7b-ac8308fcf500

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence.