Journal Article

Higher Set Point Plasma Viral Load and More-Severe Acute HIV Type 1 (HIV-1) Illness Predict Mortality among High-Risk HIV-1–Infected African Women

Ludo Lavreys, Jared M. Baeten, Varsha Chohan, R. Scott McClelland, Wisal M. Hassan, Barbra A. Richardson, Kishorchandra Mandaliya, Jeckoniah O. Ndinya Achola and Julie Overbaugh

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue 9, pages 1333-1339
Published in print May 2006 | ISSN: 1058-4838
Published online May 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/503258
Higher Set Point Plasma Viral Load and More-Severe Acute HIV Type 1 (HIV-1) Illness Predict Mortality among High-Risk HIV-1–Infected African Women

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Background. There is limited information on the natural history of human immunodeficiency virus type 1 (HIV-1) infection in Africa, especially from individuals with well-defined dates of infection. We used data from a prospective cohort study of female sex workers in Mombasa, Kenya, who were followed up monthly from before the date of HIV-1 infection.

Methods. Antiretroviral-naive women who had a well-defined date of HIV-1 infection were included in this analysis. The effects of set point plasma viral load (measured 4–24 months after infection), early CD4+ cell count, and symptoms of acute HIV-1 infection on mortality were assessed using Cox proportional hazards analysis.

Results. Among 218 women, the median duration of follow-up after HIV-1 infection was 4.6 years. Forty women died, and at 8.7 years (the time of the last death), the cumulative survival rate was 51% by Kaplan-Meier analysis. Higher set point viral load, lower early CD4+ cell count, and more-symptomatic acute HIV-1 illness each predicted death. In multivariate analysis, set point viral load (hazard ratio [HR], 2.28 per 1 log10 copies/mL increase; P = .001) and acute HIV-1 illness (HR, 1.14 per each additional symptom; P = .05) were independently associated with higher mortality.

Conclusion. Among this group of African women, the survival rate was similar to that for HIV-1–infected individuals in industrialized nations before the introduction of combination antiretroviral therapy. Higher set point viral load and more-severe acute HIV-1 illness predicted faster progression to death. Early identification of individuals at risk for rapid disease progression may allow closer clinical monitoring, including timely initiation of antiretroviral treatment.

Journal Article.  4883 words.  Illustrated.

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

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