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Rapid disease progression in HIV-1 subtype C–infected South African women.

dc.contributor.authorMlisana, Koleka Patience.
dc.contributor.authorWerner, Lise.
dc.contributor.authorGarrett, Nigel Joel.
dc.contributor.authorMcKinnon, Lyle R.
dc.contributor.authorvan Loggerenberg, Francois.
dc.contributor.authorPassmore, Jo-Ann Shelley.
dc.contributor.authorGray, Clive M.
dc.contributor.authorMorris, Lynn.
dc.contributor.authorWilliamson, Carolyn.
dc.contributor.authorAbdool Karim, Salim Safurdeen.
dc.date.accessioned2016-11-08T09:57:49Z
dc.date.available2016-11-08T09:57:49Z
dc.date.created2014
dc.date.issued2014
dc.descriptionCAPRISA, 2014.en_US
dc.description.abstractBackground. Whereas human immunodeficiency virus (HIV) subtype B–infected individuals generally progress to AIDS within 8–10 years, limited data exist for other clades, especially from Africa. We investigated rates of HIV disease progression of clade C–infected South African women. Methods. Prospective seroincidence cohorts in KwaZulu-Natal were assessed for acute HIV infection monthly (n = 245) or every 3 months (n = 594) for up to 4 years. Rapid disease progression was defined as CD4 decline to <350 cells/μL by 2 years postinfection. Serial clinical and laboratory assessments were compared using survival analysis and logistic regression models. Results. Sixty-two women were identified at a median of 42 days postinfection (interquartile range, 34–59), contributing 282 person-years of follow-up. Mean CD4 count dropped by 39.6% at 3 months and 46.7% at 6 months postinfection in women with preinfection measurements. CD4 decline to <350 cells/μL occurred in 31%, 44%, and 55% of women at 1, 2, and 3 years postinfection, respectively, and to <500 cells/μL in 69%, 79%, and 81% at equivalent timepoints. Predictors of rapid progression were CD4 count at 3 months postinfection (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.31–3.28; P = .002), setpoint viral load (HR, 3.82; 95% CI, 1.51–9.67; P = .005), and hepatitis B coinfection (HR, 4.54; 95% CI, 1.31–15.69; P = .017). Conversely, presence of any of HLAB*1302, B*27, B*57, B*5801, or B*8101 alleles predicted non–rapid progression (HR, 0.19; 95% CI, .05–.74; P = .016). Conclusions. Nearly half of subtype C–infected women progressed to a CD4 count <350 cells/μL within 2 years of infection. Implementing 2013World Health Organization treatment guidelines (CD4 count <500 cells/μL) would require most individuals to start antiretroviral therapy within 1 year of HIV infection.en_US
dc.identifier.citationMlisana, K., Werner, L., Garrett, N.J., McKinnon, L.R., van Loggerenberg, F., Passmore, J.A.S., Gray, C.M., Morris, L., Williamson, C. and Abdool Karim, S.S. 2014. Rapid Disease Progression in HIV-1 Subtype C–Infected South African Women. Clinical Infectious Diseases 59(9), 1322-1331.en_US
dc.identifier.urihttp://dx.doi.org/10.1093/cid/ciu573en_US
dc.identifier.urihttp://hdl.handle.net/10413/13616
dc.language.isoenen_US
dc.publisherOxford University Press.en_US
dc.subjectHIV disease progression.en_US
dc.subjectAcute HIV infection.en_US
dc.subjectSubtype C.en_US
dc.subjectViral load.en_US
dc.subjectWomen.en_US
dc.titleRapid disease progression in HIV-1 subtype C–infected South African women.en_US
dc.typePeer reviewed journal articleen_US

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