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Effect of HIV-1 Subtypes on Disease Progression in Rural Uganda: A Prospective Clinical Cohort Study

OBJECTIVE: We examined the association of HIV-1 subtypes with disease progression based on three viral gene regions. DESIGN: A prospective HIV-1 clinical cohort study in rural Uganda. METHODS: Partial gag, env and pol genes were sequenced. Cox proportional hazard regression modelling was used to est...

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Detalles Bibliográficos
Autores principales: Ssemwanga, Deogratius, Nsubuga, Rebecca N., Mayanja, Billy N., Lyagoba, Frederick, Magambo, Brian, Yirrell, Dave, Van der Paal, Lieve, Grosskurth, Heiner, Kaleebu, Pontiano
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3741119/
https://www.ncbi.nlm.nih.gov/pubmed/23951241
http://dx.doi.org/10.1371/journal.pone.0071768
Descripción
Sumario:OBJECTIVE: We examined the association of HIV-1 subtypes with disease progression based on three viral gene regions. DESIGN: A prospective HIV-1 clinical cohort study in rural Uganda. METHODS: Partial gag, env and pol genes were sequenced. Cox proportional hazard regression modelling was used to estimate adjusted hazard ratios (aHRs) of progression to: CD4≤250, AIDS onset and death, adjusted for sex, age and CD4 count at enrolment. RESULTS: Between 1990 and 2010, 292 incident cases were subtyped: 25% had subtype A, 45% had D, 26% had A/D recombinants, 1% had C and 4% were other recombinant forms. Of the 278 incident cases included in the disease progression analysis, 62% progressed to CD4≤250, 32% to AIDS, and 34% died with a higher proportion being among subtype D cases. The proportions of individuals progressing to the three endpoints were significantly higher among individuals infected with subtype D. Throughout the study period, individuals infected with subtype D progressed faster to CD4≤250, adjusted HR (aHR), (95% CI) = 1.72 (1.16–2.54), but this was mainly due to events in the period before antiretroviral therapy (ART) introduction, when individuals infected with subtype D significantly progressed faster to CD4≤250 than subtype A cases; aHR (95% CI) = 1.78 (1.01–3.14). CONCLUSIONS: In this population, HIV-1 subtype D was the most prevalent and was associated with faster HIV-1 disease progression than subtype A. Further studies are needed to examine the effect of HIV-1 subtypes on disease progression in the ART period and their effect on the virological and immunological ART outcomes.