Control of the HIV-1 Load Varies by Viral Subtype in a Large Cohort of African Adults With Incident HIV-1 Infection.

Matt A Price; Wasima Rida; William Kilembe; Etienne Karita; Mubiana Inambao; Eugene Ruzagira ORCID logo; Anatoli Kamali; Eduard J Sanders; Omu Anzala; Eric Hunter; +18 more... Susan Allen; Vinodh A Edward; Kristin M Wall; Jianming Tang; Patricia E Fast; Pontiano Kaleebu ORCID logo; Shabir Lakhi; Gaudensia Mutua; Linda Gail Bekker; Ggayi Abu-Baker; Amanda Tichacek; Paramesh Chetty; Mary H Latka; Pholo Maenetje; Heeran Makkan; Freddie Kibengo; Fran Priddy; Jill Gilmour; (2019) Control of the HIV-1 Load Varies by Viral Subtype in a Large Cohort of African Adults With Incident HIV-1 Infection. The Journal of infectious diseases, 220 (3). pp. 432-441. ISSN 0022-1899 DOI: 10.1093/infdis/jiz127
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Few human immunodeficiency virus (HIV)-infected persons can maintain low viral levels without therapeutic intervention. We evaluate predictors of spontaneous control of the viral load (hereafter, "viral control") in a prospective cohort of African adults shortly after HIV infection. Viral control was defined as ≥2 consecutively measured viral loads (VLs) of ≤10 000 copies/mL after the estimated date of infection, followed by at least 4 subsequent measurements for which the VL in at least 75% was ≤10 000 copies/mL in the absence of ART. Multivariable logistic regression characterized predictors of viral control. Of 590 eligible volunteers, 107 (18.1%) experienced viral control, of whom 25 (4.2%) maintained a VL of 51-2000 copies/mL, and 5 (0.8%) sustained a VL of ≤50 copies/mL. The median ART-free follow-up time was 3.3 years (range, 0.3-9.7 years). Factors independently associated with control were HIV-1 subtype A (reference, subtype C; adjusted odds ratio [aOR], 2.1 [95% confidence interval {CI}, 1.3-3.5]), female sex (reference, male sex; aOR, 1.8 [95% CI, 1.1-2.8]), and having HLA class I variant allele B*57 (reference, not having this allele; aOR, 1.9 [95% CI, 1.0-3.6]) in a multivariable model that also controlled for age at the time of infection and baseline CD4+ T-cell count. We observed strong associations between infecting HIV-1 subtype, HLA type, and sex on viral control in this cohort. HIV-1 subtype is important to consider when testing and designing new therapeutic and prevention technologies, including vaccines.


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HIV-1 viral control varies by viral subtype in a large cohort of African adults with incident HIV-1 infection.pdf
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