Rapid Disease Progression in HIV-1 Subtype C–Infected South African Women. (17th July 2014)

• Record Type: Journal Article
• Authors: Mlisana, Koleka; Werner, Lise; Garrett, Nigel J.; McKinnon, Lyle R.; van Loggerenberg, Francois; Passmore, Jo-Ann S.; Gray, Clive M.; Morris, Lynn; Williamson, Carolyn; Abdool Karim, Salim S.
• Is Part Of: Clinical infectious diseases. Volume 59:Number 9(2014:May 01)
• Page Start: 1322
• Page End: 1331
• Publication Date: 2014-07-17
• Subjects: HIV disease progression -- acute HIV infection -- subtype C -- viral load -- women; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciu573
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : This study shows that one-third of HIV subtype C–infected women require antiretroviral therapy within 12 months of infection, increasing to 69% if the initiation CD4 count is 500 cells/µL. This has significant implications for program implementation, resource allocation, and HIV prevention. Abstract: Background. Whereas human immunodeficiency virus (HIV) subtype B–infected individuals generally progress to AIDS within 8–10 years, limited data exist for other clades, especially from Africa. We investigated rates of HIV disease progression of clade C–infected South African women. Methods. Prospective seroincidence cohorts in KwaZulu-Natal were assessed for acute HIV infection monthly (n = 245) or every 3 months (n = 594) for up to 4 years. Rapid disease progression was defined as CD4 decline to <350 cells/µL by 2 years postinfection. Serial clinical and laboratory assessments were compared using survival analysis and logistic regression models. Results. Sixty-two women were identified at a median of 42 days postinfection (interquartile range, 34–59), contributing 282 person-years of follow-up. Mean CD4 count dropped by 39.6% at 3 months and 46.7% at 6 months postinfection in women with preinfection measurements. CD4 decline to <350 cells/µL occurred in 31%, 44%, and 55% of women at 1, 2, and 3 years postinfection, respectively, and to <500 cells/µL in 69%, 79%, and 81% at equivalent timepoints. Predictors of rapid progression were CD4 count at 3 months postinfection (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.31–3.28; P = .002), setpoint viral load (HR, 3.82; 95% CI, 1.51–9.67; P = .005), and hepatitis B coinfection (HR, 4.54; 95% CI, 1.31–15.69; P = .017). Conversely, presence of any of HLAB*1302, B*27, B*57, B*5801, or B*8101 alleles predicted non–rapid progression (HR, 0.19; 95% CI, .05–.74; P = .016). Conclusions. Nearly half of subtype C–infected women progressed to a CD4 count <350 cells/µL within 2 years of infection. Implementing 2013 World Health Organization treatment guidelines (CD4 count <500 cells/µL) would require most individuals to start antiretroviral therapy within 1 year of HIV infection.