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 log 10 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.

In 20 patients who had suffered a first right hemisphere stroke, we examined the prevalence of double dissociations between the results of a star cancellation and a line bisection test. Both are common methods to assess spatial hemineglect. Within the group of neglect patients, we found no significant correlation between the two tasks. Furthermore, 5 patients with impaired performance on one of the tests were within the normal range on the other one. In agreement with experimental studies, we argue that spatial hemineglect is not a unitary syndrome. Furthermore, the findings in one of our patients are compatible with the view that an isolated deficit on cancellation tasks might follow from a lesion in the right anterior cingulate gyrus.

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