Control of the HIV-1 Load Varies by Viral Subtype in a Large Cohort of African Adults With Incident HIV-1 Infection

• Type of Material: Article
• Authors: Matt A. Price, University of California, San Francisco; Wasima Rida, Rwanda Zambia HIV Research Group; William Kilembe, Rwanda Zambia HIV Research Group; Etienne Karita, Rwanda Zambia HIV Research Group; Mubiana Inambao, Rwanda Zambia HIV Research Group; Eugene Ruzagira, MRC/UVRI Uganda Research Unit on AIDS; Anatoli Kamali, International AIDS Vaccine Initiative; Eduard J Sanders, Kenyan Medical Research Institute; Omu Anzala, KAVI Institute of Clinical Research; Eric Hunter, Emory University; Susan Allen, Emory University; Vinodh A. Edward, Yale University; Kristin Wall, Emory University; Jianming Tang, University of Alabama; Patricia E. Fast, International AIDS Vaccine Initiative; Pontiano Kaleebu, MRC/UVRI Uganda Research Unit on AIDS; Shabir Lakhi, Rwanda Zambia HIV Research Group; Gaudensia Mutua, KAVI Institute of Clinical Research; Linda Gail Bekker, Desmond Tutu HIV Foundation; Ggayi Abu-Baker, MRC UVRI Uganda Res Unit AIDS; Amanda Tichacek, Rwanda Zambia HIV Res Grp; Paramesh Chetty, International AIDS Vaccine Initiative; Mary H. Latka, University of Witwatersrand; Pholo Maenetje, University of Witwatersrand; Heeran Makkan, University of Witwatersrand; Freddie Kibengo, MRC UVRI Uganda Res Unit AIDS; Fran Priddy, International AIDS Vaccine Initiative; Jill Gilmour, Int AIDS Vaccine Initiat Human Immunol Lab
• Language: English
• Date: 2019-08-01
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/infdis/jiz127
• Title of Journal or Parent Work: Journal of Infectious Diseases
• ISSN: 0022-1899
• Volume: 220
• Issue: 3
• Start Page: 432
• End Page: 441
• Grant/Funding Information: This study was sponsored by the International AIDS Vaccine Initiative (IAVI), which in turn is funded by many donors, including the Bill and Melinda Gates Foundation, the Ministry of Foreign Affairs of Denmark, Irish Aid, the Ministry of Finance of Japan in partnership with The World Bank, the Ministry of Foreign Affairs of the Netherlands, the Norwegian Agency for Development Cooperation, the United Kingdom Department for International Development, and the US Agency for International Development (the full list of IAVI donors is available at: http://www.iavi.org).
• Keywords: Science & Technology; IMMUNODEFICIENCY-VIRUS TYPE-1; DETERMINANTS; Immunology; Microbiology; VIREMIC CONTROLLERS; epidemiology; HOST; TRANSMISSION; ELITE; Life Sciences & Biomedicine; Infectious Diseases; DISEASE PROGRESSION; Africa; AIDS; HIV subtype; HIV
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Health Sciences, Immunology

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.