The effect of human immunodeficiency virus (HIV) type 1 envelope subtypes A and D on disease progression was investigated in 1045 adults in Uganda. At enrollment and every 6 months, a clinical history, examination, and laboratory investigations that included CD4 cell counts were done. HIV-1 envelope subtype was assessed mainly by peptide serology supplemented by heteroduplex mobility assay and DNA sequencing. A multivariate analysis of survival was performed to assess the prognostic value of HIV-1 subtype on death. A marginal general linear model also determined the effect of subtype on CD4 cell count during follow-up. Subtype D was associated with faster progression to death (relative risk, 1.29; 95% confidence interval, 1.07-1.56; P=.009) and with a lower CD4 cell count during follow-up (P=.001), compared with subtype A, after adjusting for CD4 cell count at enrollment. In Africa, envelope subtype D is associated with faster disease progression, compared with subtype A.

Table of Contents 1. Levels of evidence1.1 Reference2. Introduction3. Auditable targets4. Table summaries4.1 Initial diagnosis4.2 Assessment of ART‐naïve individuals4.3 ART initiation4.4 Initial assessment following commencement of ART4.5 Routine monitoring on ART4.6 References5. Newly diagnosed and transferring HIV‐positive individuals5.1 Initial HIV‐1 diagnosis5.2 Tests to determine whether acquisition of HIV infection is recent5.3 Individuals transferring care from a different HIV healthcare setting5.4 Communication with general practitioners and shared care5.5 Recommendations5.6 References6. Patient history6.1 Initial HIV‐1 diagnosis6.2 Monitoring of ART‐naïve patients6.3 Pre‐ART initiation assessment6.4 Monitoring individuals established on ART6.5 Assessment of adherence6.6 Recommendations6.7 References7. Examination7.1 Recommendations8. Identifying the need for psychological support8.1 References9. Assessment of immune status9.1 CD4 T cell counts9.2 CD4 T cell percentage9.3 References10. HIV viral load10.1 Initial diagnosis/ART naïve10.2 Post ART initiation10.3 Individuals established on ART10.4 Recommendations10.5 References11. Technical aspects of viral load testing11.1 References12. Viral load kinetics during ART and viral load ‘blips’12.1 References13. Proviral DNA load13.1 References14. Resistance testing14.1 Initial HIV‐1 diagnosis14.2 ART‐naïve14.3 Post treatment initiation14.4 ART‐experienced14.5 References15. Subtype determination15.1 Disease progression15.2 Transmission15.3 Performance of molecular diagnostic assays15.4 Response to therapy15.5 Development of drug resistance15.6 References16. Other tests to guide use of specific antiretroviral agents16.1 Tropism testing16.2 HLA B*5701 testing16.3 References17. Therapeutic drug monitoring17.1 Recommendations17.2 References18. Biochemistry testing18.1 Introduction18.2 Liver function18.3 Renal function18.4 Dyslipidaemia in HIV‐infected individuals18.5 Other biomarkers18.6 Bone disease in HIV‐infected patients18.7 References19. Haematology19.1 Haematological assessment and monitoring19.2 Recommendations19.3 References20. Serology20.1 Overview20.2 Hepatitis viruses20.3 Herpes viruses20.4 Measles and rubella20.5 Cytomegalovirus (CMV)20.6 References21. Other microbiological screening21.1 Tuberculosis screening21.2 Toxoplasma serology21.3 Tropical screening21.4 References22. Sexual health screening including anal and cervical cytology22.1 Sexual history taking, counselling and sexually transmitted infection (STI) screening22.2 Cervical and anal cytology22.3 Recommendations22.4 References23. Routine monitoring recommended for specific patient groups23.1 Women23.2 Older age23.3 Injecting drug users23.4 Individuals coinfected with HBV and HCV23.5 Late presenters23.6 References Appendix

These subtype differences in coreceptor use may partially explain the faster progression rates we have previously reported in individuals infected with subtype D compared with subtype A. Our observations may have implications for the future use of coreceptor inhibitors in this population.

Human immunodeficiency virus (HIV) infection