Ms. P. decided to have an HIV test after finding out that an old boyfriend had HIV. She was shocked to hear the news at first and went to the testing clinic knowing there was a chance of infection, but she was confident that she was in good health overall, and had not been sick or had any unusual symptoms. She had dated this boyfriend for about 3 months at least six years ago but they just didn't "click." Eventually, they went their own ways and began dating other people. Several years ago, she moved to a nearby city and changed jobs. She only found out abut his illness by chance when she happened to meet a mutual friend at an art festival.

When the test results came back positive she could not believe it at first. Then, all at once, she began to think about men she had been involved with since. How many had she infected?

Ms. P. was given an appointment at an HIV treatment center to discuss the need for antiretroviral therapy. Before beginning therapy, the provider ordered a genotype test to identify any possible viral resistance she might have. When the results were back, she was informed that she had been infected with a strain of virus that was multi-drug resistant (MDR). In other words, many of the commonly used medications for HIV would not provide effective treatment. The provider also explained that infection with HIV that is MDR is more common than many people realize. In one recent study in NY City, 10% of people newly diagnosed with HIV had MDR, and more than 25% had at least some resistance (Shet et al., 12^th CROI, 2005). Medications would need to be carefully selected to provide the best treatment possible. Even so, infection with a strain of MDR HIV makes progression to AIDS and death more likely.