Abstract
Human immunodeficiency virus type 1 (HIV-1) subtypes have been shown to differ in the rate of clinical progression. We studied the association between HIV-1 subtypes and the rate of CD4+ T-cell recovery in a longitudinal cohort of patients on combination antiretroviral therapy (cART). We studied 103 patients infected with CRF01_AE (69%) and subtype B (31%) who initiated cART between 2006 and 2013. Demographic data, CD4+ T-cell counts and HIV-1 viral load were abstracted from patient medical charts. Kaplan-Meier was used to estimate the time to CD4+ T-cell count increase to ≥350 between subtypes and effects of covariates were analysed using Cox proportional hazards. An 87% of the study population were male adults (mean age of 38.7 years old). Baseline CD4+ T-cell counts and viral loads, age at cART initiation, sex, ethnicity and co-infection did not differ significantly between subtypes. A shorter median time for CD4+ T-cell count increase to ≥350 cells/μL was observed for CRF01_AE (546 days; 95% confidence interval [CI], 186–906 days; P = .502) compared to subtype B (987 days; 95% CI, 894–1079 days). In multivariate analysis, female sex was significantly associated with a 2.7 times higher chance of achieving CD4+ T-cell recovery (adjusted hazard ratio [HR], 2.75; 95% CI, 1.21–6.22; P = .025) and both baseline CD4+ T-cell count (P = .001) and viral load (P = .001) were important predictors for CD4+ T-cell recovery. Immunological recovery correlated significantly with female sex, baseline CD4+ T-cell counts and viral load but not subtype.
Highlights
The Human immunodeficiency virus type 1 (HIV-1) epidemic involves the co-circulation of genetically-diverse subtypes of group M, comprising of 11 subtypes or sub-subtypes and 72 circulating recombinant forms (CRF)
The present study examined the rate of CD4+ T-cell recovery in a retrospective patient cohort initiating combination antiretroviral therapy (cART) and infected with CRF01_AE or subtype B in Kuala Lumpur, Malaysia
Since the advent of cART in the 1990s, a longer life expectancy and better prognosis are attainable among 12.9 million people living with HIV worldwide
Summary
The HIV-1 epidemic involves the co-circulation of genetically-diverse subtypes of group M, comprising of 11 subtypes or sub-subtypes and 72 circulating recombinant forms (CRF). HIV-1 Subtype and Rate of CD4+ T-Cell Recovery (PLHIV) and CRF01_AE is the major circulating subtype (comprising approximately 80% of the total HIV-1 infections) besides subtype B [1]. Both genetically distinct lineages have been circulating in the region since their first description in the 1980s, and have been targeted in vaccine trials including the recent RV144 trial [2]. In a cohort of female commercial sex workers in West Africa, the rate of disease progression to AIDS was eight-fold higher in the study population infected with non-A subtypes (C, D and G) compared to subtype A [6]. White individuals infected with subtype B experienced higher rates of virological failure following the initiation of combination antiretroviral therapy (cART) compared to non-B subtypes (CRF02_AG, CRF01_AE, A and C) [7]
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