Control of the HIV-1 load varies by viral subtype in a large cohort of African adults with incident HIV-1 infection

MA Price, W Rida, W Kilembe, E Karita… - The Journal of …, 2019 - academic.oup.com
MA Price, W Rida, W Kilembe, E Karita, M Inambao, E Ruzagira, A Kamali, EJ Sanders…
The Journal of infectious diseases, 2019academic.oup.com
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 …
Abstract
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.
Oxford University Press