Abstract
BackgroundThe life expectancy of people living with HIV (PLWH) remains shorter than that of the general population, despite significant improvement in the recent years. Mortality in HIV-infected individuals may be associated with a higher viral load at of diagnosis, a lower CD4 count, or clinical variables such as sex or route of transmission. This article investigated the role of the HLA-B*5701 varian on mortality among PLWH.MethodsMaterial for the analysis consist of the data of 2,393 patients for whom the HLA-B*57 variant was known. Those patients were followed under the care of the Infectious Diseases Hospital in Warsaw (n = 1555) and the Clinic of Acquired Immunodeficiency of the Pomeranian Medical University in Szczecin (n = 838). Factors such as age, gender, date of HIV diagnosis, route of transmission, date of death, baseline HIV viral load and baseline CD4 counts, were collected, and end-point cross-sectional analyses were marked at 60, 120, 180 and 240 month of observation.ResultsHLA-B*5701 allele was found in 133 (5.5%) analyzed cases. Median age was notably higher for HLA-B*5701 positive patients [32.7 (28.3–41.3) vs. 31.6 (26.8–38.3)years p = 0.02]. HLA-B*5701 was associated with lower baseline viral load [4.21 (3.5–4.8) vs. 4.79 (4.2–5.3)log copies/ml p<0.001] and higher CD4count [448 (294.5–662) vs. 352 (176–514) cells/μl p<0.001]. There were no association between HLA-B*5701 and survival for any given end-point. Higher mortality was associated to male gender, intravenous drug users, lower CD4 count at baseline and higher baseline viral load.ConclusionsIn our study, the presence of HLA-B*5701 allel was not associated with mortality rate of HIV infected patients, irrespective of being associated with both higher baseline CD4 + cell count and lower baseline HIV viral load.
Highlights
Despite notable survival disparities in the early HIV epidemics, following the introduction of combined antiretroviral therapy the life span of people living with HIV (PLWH) is currently approaching the life expectancy of HIV uninfected individuals
HLA-B*5701 was associated with lower baseline viral load [4.21 (3.5–4.8) vs. 4.79 (4.2–5.3)log copies/ml p
Higher mortality was associated to male gender, intravenous drug users, lower CD4 count at baseline and higher baseline viral load
Summary
Despite notable survival disparities in the early HIV epidemics, following the introduction of combined antiretroviral therapy (cART) the life span of people living with HIV (PLWH) is currently approaching the life expectancy of HIV uninfected individuals. Mortality risk remains associated with the delayed HIV diagnosis, despite observed progress in the cART efficacy and widespread implementation of the CD4 count threshold unrestricted initiation schemes [2,3,4]. Survival remains dependent on the presence of the array of risk factors, which invariably include AIDS-defining illnesses, malignancy or suicide [8]. Alongside with these key factors affecting HIV mortality, a wide array of genetic factors may influence survival in this group mostly by affecting HIV viral load or the tempo of lymphocyte CD4 decay. This article investigated the role of the HLA-B*5701 varian on mortality among PLWH
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