Journal Article

Different Rates of Disease Progression of HIV Type 1 Infection in Tanzania Based on Infecting Subtype

Ashwin Vasan, Boris Renjifo, Ellen Hertzmark, Beth Chaplin, Gernard Msamanga, Max Essex, Wafaie Fawzi and David Hunter

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue 6, pages 843-852
Published in print March 2006 | ISSN: 1058-4838
Published online March 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/499952
Different Rates of Disease Progression of HIV Type 1 Infection in Tanzania Based on Infecting Subtype

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Background. Many different subtypes of human immunodeficiency virus (HIV) type 1 have been identified, particularly in sub-Saharan Africa. However, much remains unknown regarding the relative pathogenicity of these subtypes and their influence on the clinical progression of HIV infection. We examined prospectively the associations between HIV-1 subtypes A, C, and D and recombinant viruses, as well as the rates of disease progression in a cohort of seropositive women from Dar es Salaam, Tanzania.

Methods. A total of 428 pregnant mothers participating in a larger controlled trial of the effect of vitamin supplements were selected for DNA sequencing of their HIV-1 subtype. Plasma viral load was measured at baseline, and CD4+ cell counts was assessed at baseline and at regular intervals throughout the follow-up period. Proportional hazards regression (hazards ratio [HR]) analysis was used to measure the association between viral subtype and the rate of disease progression.

Results. Relative to patients with subtype A, patients with subtype D experienced the most rapid progression to death (HR, 2.27; 95% confidence interval [CI], 1.46–3.52) or to the World Health Organization stage 4 of illness (HR, 1.94; 95% CI, 1.20–3.14) and to a CD4+ cell count of <200 cells/mm3 (HR, 2.12; 95% CI, 1.42–3.17). After adjustment for viral load, CD4+ cell count, and other baseline covariates, the associations remained similar.

Conclusions. We observed heterogeneity in the rates of disease progression of HIV-1 disease in infected persons, on the basis of the infecting subtype. Subtype D was associated with the most rapid progression of the disease, relative to the other 3 categories of viruses in our cohort.

Journal Article.  5127 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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