Emergence of HIV-1 mutated strains after interruption of highly active antiretroviral therapy in chronically infected patients.

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We report the emergence of HIV-1 mutated strains after long-term viral suppression in four patients who interrupted highly active antiretroviral therapy (HAART). In two cases, mutations pre-existed in proviral DNA before HAART interruption. All mutations were associated with resistance to nucleoside reverse transcriptase inhibitors, and three of the four patients had prolonged periods of monotherapy or dual therapy. Resistant strains may re-emerge rapidly even in patients harbouring a majority of wild-type virus in proviral DNA before treatment interruption.