Journal article
Disease progression by infecting HIV-1 subtype in a seroconverter cohort in sub-Saharan Africa
- Abstract:
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Objective: To describe immunologic, virologic, and clinical HIV disease progression by HIV-1 subtype among Africans with well documented estimated dates of HIV infection (EDIs).
Design: Prospective cohort.
Methods: Adults and youth with documented HIV-1 infection in the past 12 months were recruited from seroincidence cohorts in East and Southern Africa and followed at 3–6 month intervals. Blood for lymphocyte subset and viral load determination was collected at each visit. Pol was sequenced from the first positive specimen to ascertain subtype. Preantiretroviral therapy disease progression was measured by three time-to-event endpoints: CD4+ cell count 350 cells/μl or less, viral load measurement at least 1 × 105 copies/ml, and clinical AIDS.
Results: From 2006 to 2011, 615 participants were enrolled at nine research centers in Kenya, Rwanda, South Africa, Uganda, and Zambia; 579 (94.1%) had viral subtyping completed. Predominant subtypes were C (256, 44.2%), A (209, 36.1%), and D (84, 14.5%). After adjustment for age, sex, and human leukocyte antigen alleles in Cox regression analyses, subtype C-infected participants progressed faster than subtype A to all three endpoints [CD4+ hazard ratio 1.60, 95% (confidence interval) CI 1.16, 2.20; viral load hazard ratio 1.59, 95% CI 1.12, 2.25; and AIDS hazard ratio 1.60, 95% CI 1.11, 2.31). Subtype D-infected participants reached high viral load more rapidly (hazard ratio 1.61, 95% CI 1.01, 2.57) and progressed nearly twice as fast to AIDS compared to subtype A (hazard ratio 1.93, 95% CI 1.21, 3.09).
Conclusion: Subtype-specific differences in HIV disease progression suggest that the local subtype distribution be considered when planning HIV programs and designing and defining clinical endpoints for HIV prevention trials.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 411.6KB, Terms of use)
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(Supplementary materials, doc, 63.8KB, Terms of use)
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- Publisher copy:
- 10.1097/qad.0000000000000012
Authors
- Funder identifier:
- https://ror.org/00k86s890
- Funder identifier:
- https://ror.org/01n6e6j62
- Funder identifier:
- https://ror.org/04zbn7k04
- Publisher:
- Lippincott, Williams and Wilkins
- Journal:
- AIDS More from this journal
- Volume:
- 27
- Issue:
- 17
- Pages:
- 2775-2786
- Publication date:
- 2013-11-01
- Acceptance date:
- 2013-07-17
- DOI:
- EISSN:
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1473-5571
- ISSN:
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0269-9370
- Language:
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English
- Keywords:
- Pubs id:
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pubs:434349
- UUID:
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uuid:72395783-9a5e-46fb-8cbb-6be285f9d10b
- Local pid:
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pubs:434349
- Source identifiers:
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434349
- Deposit date:
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2013-11-17
- ARK identifier:
Terms of use
- Copyright holder:
- Wolters Kluwer Health
- Copyright date:
- 2013
- Rights statement:
- © 2013 Wolters Kluwer Health | Lippincott Williams and Wilkins. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
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