Effect of Human Immunodeficiency Virus (HIV) Type 1 Envelope Subtypes A and D on Disease Progression in a Large Cohort of HIV‐1–Positive Persons in Uganda

Abstract

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.

The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian-European collaborative retrospective cohort study

“…For example, faster immunologic progression has been reported in patients from Uganda and Kenya with viral subtype D compared with viral subtype A. [28][29][30] Co-evolution of HIV-1 subtypes and African populations may reduce the virulence of more dominant viral subtypes, such as subtype C, possibly leading to an interaction Estimates were made using separate mixed models: one for patients of African ancestry and one for patients of other ethnicities and represent CD4 cell counts in a male patient with infection not transmitted by injection drug use and with age and initial HIV RNA set at the median for that ethnicity and subtype. CD4 cell count trajectories are shown for a 10% sample of patients of African ancestry with viral subtype C and for a 1% sample of patients of other ethnicities with viral subtype B.…”

“…Patients included in this study were undergoing treatment in countries with publicly funded health care, minimizing the potential effects of health care access and quality on immunologic progression, but our results might not be generalizable to resource-limited settings. We did not have enough patients with other viral subtypes linked to faster CD4 cell count decline, such as viral subtype D. [28][29][30]40 In addition, limited numbers of both viral subtypes G and CRF01_AE in patients of African ancestry means our estimates for these subtypes were imprecise. We were not able to adjust for sociodemographic factors beyond age and sex.…”

HIV Dementia among HIV Positive People at Debre Markos Hospital, Northwest Ethiopia

“…People with dementia also are less likely to practice safe sex [10]. Of the estimated 40 million adults and children worldwide who are living with HIV infection, an estimated 27 million live in sub-Saharan Africa [10], [11], [12], [13].…”

Genetic Diversity and the Human Immunodeficiency Virus Type-1: Implications and Impact

“…This is in keeping with what is known of the natural progression of HIV infection (Fox et al, 2008). Although disease progression in HIV-1 infected patients has been linked with HIV-1 subtypes the impact of different subtypes was not assessed in this study as the overwhelming majority of patients were infected with subtype B (Baeten , 2007;Kaleebu, 2002;Kanki, 1999). The impact of antiretroviral treatment on disease progression was evident as the CD4 T cell counts were significantly lower in the group of antiretroviral drug treated patients and similar in the group of patients on antiretroviral therapy irrespective of age (Harari, 2004;Hogg, 1999).…”