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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Impact of HIV-1 viral subtype on disease progression and response to antiretroviral therapy
Journal of the International AIDS Society, Volume 13, No. 1, Article 4, Year 2010
Notification
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Description
Background. Our intention was to compare the rate of immunological progression prior to antiretroviral therapy (ART) and the virological response to ART in patients infected with subtype B and four non-B HIV-1 subtypes (A, C, D and the circulating recombinant form, CRF02-AG) in an ethnically diverse population of HIV-1-infected patients in south London. Methods. A random sample of 861 HIV-1-infected patients attending HIV clinics at King's and St Thomas' hospitals' were subtyped using an in-house enzyme-linked immunoassay and env sequencing. Subtypes were compared on the rate of CD4 cell decline using a multi-level random effects model. Virological response to ART was compared using the time to virological suppression (< 400 copies/ml) and rate of virological rebound (> 400 copies/ml) following initial suppression. Results. Complete subtype and epidemiological data were available for 679 patients, of whom 357 (52.6%) were white and 230 (33.9%) were black African. Subtype B (n = 394) accounted for the majority of infections, followed by subtypes C (n = 125), A (n = 84), D (n = 51) and CRF02-AG (n = 25). There were no significant differences in rate of CD4 cell decline, initial response to highly active antiretroviral therapy and subsequent rate of virological rebound for subtypes B, A, C and CRF02-AG. However, a statistically significant four-fold faster rate of CD4 decline (after adjustment for gender, ethnicity and baseline CD4 count) was observed for subtype D. In addition, subtype D infections showed a higher rate of virological rebound at six months (70%) compared with subtypes B (45%, p = 0.02), A (35%, p = 0.004) and C (34%, p = 0.01). Conclusions. This is the first study from an industrialized country to show a faster CD4 cell decline and higher rate of subsequent virological failure with subtype D infection. Further studies are needed to identify the molecular mechanisms responsible for the greater virulence of subtype D. © 2010 Easterbrook et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Easterbrook, Philippa Jane
United Kingdom, London
Faculty of Life Sciences & Medicine
Smith, Melvyn Howard
United Kingdom, London
Public Health England
Mullen, Jane E.
United Kingdom, London
St Thomas' Hospital
O'Shea, Siobhan
United Kingdom, London
St Thomas' Hospital
Chrystie, Ian L.
United Kingdom, London
St Thomas' Hospital
de Ruiter, Annemiek
United Kingdom, London
St Thomas' Hospital
Geretti, Anna María
United Kingdom, London
The Royal Free Hospital
Statistics
Citations: 114
Authors: 7
Affiliations: 5
Identifiers
Doi:
10.1186/1758-2652-13-4
ISSN:
17582652
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study