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

• 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
• Journal Title: Journal of Infectious Diseases
• Volume: Volume 220, Number 3
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C | 2019-08-01, Pages 432-441
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/infdis/jiz127
• Subjects: Health Sciences, Epidemiology; Health Sciences, Immunology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Microbiology; HIV; AIDS; Africa; epidemiology; HIV subtype; IMMUNODEFICIENCY-VIRUS TYPE-1; DISEASE PROGRESSION; VIREMIC CONTROLLERS; TRANSMISSION; HOST; DETERMINANTS; ELITE

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.