{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T18:54:51Z","timestamp":1773341691476,"version":"3.50.1"},"reference-count":15,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Italian Ministry of Health","doi-asserted-by":"publisher","award":["Ricerca Corrente, Progetto 1, Linea 2"],"award-info":[{"award-number":["Ricerca Corrente, Progetto 1, Linea 2"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>We report the case of a 48-year-old man admitted with severe pneumonia, profound immunosuppression and multiple co-infections, showing unusual pattern of HIV-1 viremia. With the Aptima HIV-1 Quant Dx assay, a dual-target diagnostic assay for monitoring of viral RNA in people living with HIV-1 (PWH), the patient showed viral RNA consistently detected exclusively through the pol target, while the LTR signal remained absent in all samples during one year of follow-up on antiretroviral therapy. Despite this persistent atypical viral load (pol+\/LTR-), near full-length next-generation sequencing of HIV-1 RNA confirmed an almost intact viral genome, including the LTR region and no resistance-associated mutations. Several mechanisms may account for explaining the persistent lack of LTR detection, such as defective quasi-species, RNA structural rearrangements, or epi-transcriptomic modifications interfering with primers annealing, and further studies are currently underway to clarify the biological origins and the clinical implications of the detection patterns of atypical HIV-1 RNA. The case described here is an example of a few PWH undergoing antiretroviral therapy who demonstrated single-target HIV-1 viremia with the Aptima dual-target assay. These particular clinical situations with single-target viremia, even at high levels of HIV-1 RNA, should be carefully considered in clinical management as they would indicate the presence of atypical viral RNA, for which, in some cases, switching antiretroviral therapy could be not necessary.<\/jats:p>","DOI":"10.3390\/ijms27062595","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T09:23:03Z","timestamp":1773307383000},"page":"2595","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Atypical HIV-1 Viremia Persistently Detected Exclusively Through the Pol Target by a Dual-Target (Pol and LTR) Assay: A Case Report About a New Diagnostic Challenge"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7063-0222","authenticated-orcid":false,"given":"Alessandra","family":"Amendola","sequence":"first","affiliation":[{"name":"Laboratory of Virology and Laboratories of Biosecurity, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Belladonna","sequence":"additional","affiliation":[{"name":"Laboratory of Virology and Laboratories of Biosecurity, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flavia","family":"Smoquina","sequence":"additional","affiliation":[{"name":"Laboratory of Virology and Laboratories of Biosecurity, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0304-6712","authenticated-orcid":false,"given":"Giulia","family":"Capecchi","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0240-7504","authenticated-orcid":false,"given":"Valentina","family":"Mazzotta","sequence":"additional","affiliation":[{"name":"Clinical Department, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6100-8442","authenticated-orcid":false,"given":"Maria Grazia","family":"Bocci","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7489-5271","authenticated-orcid":false,"given":"Fabrizio","family":"Maggi","sequence":"additional","affiliation":[{"name":"Laboratory of Virology and Laboratories of Biosecurity, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3954-5679","authenticated-orcid":false,"given":"Federica","family":"Forbici","sequence":"additional","affiliation":[{"name":"Laboratory of Virology and Laboratories of Biosecurity, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2975-8611","authenticated-orcid":false,"given":"Lavinia","family":"Fabeni","sequence":"additional","affiliation":[{"name":"Laboratory of Virology and Laboratories of Biosecurity, National Institute for Infectious Diseases \u201cLazzaro Spallanzani\u201d\u2014IRCCS, 00149 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref_1","unstructured":"(2026, January 07). 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Virol."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/6\/2595\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T09:30:35Z","timestamp":1773307835000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/6\/2595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":15,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["ijms27062595"],"URL":"https:\/\/doi.org\/10.3390\/ijms27062595","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]}}}