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HIV Type 1 Disease Progression to AIDS and Death in a Rural Ugandan Cohort Is Primarily Dependent on Viral Load Despite Variable Subtype and T-Cell Immune Activation Levels.


ABSTRACT: Untreated human immunodeficiency virus type 1 (HIV) infection is associated with persistent immune activation, which is an independent driver of disease progression in European and United States cohorts. In Uganda, HIV-1 subtypes A and D and recombinant AD viruses predominate and exhibit differential rates of disease progression.HIV-1 seroconverters (n = 156) from rural Uganda were evaluated to assess the effects of T-cell activation, viral load, and viral subtype on disease progression during clinical follow-up.The frequency of activated T cells was increased in HIV-1-infected Ugandans, compared with community matched uninfected individuals, but did not differ significantly between viral subtypes. Higher HIV-1 load, subtype D, older age, and high T-cell activation levels were associated with faster disease progression to AIDS or death. In a multivariate Cox regression analysis, HIV-1 load was the strongest predictor of progression, with subtype also contributing. T-cell activation did not emerge an independent predictor of disease progression from this particular cohort.These findings suggest that the independent contribution of T-cell activation on morbidity and mortality observed in European and North American cohorts may not be directly translated to the HIV epidemic in East Africa. In this setting, HIV-1 load appears to be the primary determinant of disease progression.

SUBMITTER: Eller MA 

PROVIDER: S-EPMC4425824 | biostudies-other | 2015 May

REPOSITORIES: biostudies-other

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HIV Type 1 Disease Progression to AIDS and Death in a Rural Ugandan Cohort Is Primarily Dependent on Viral Load Despite Variable Subtype and T-Cell Immune Activation Levels.

Eller Michael A MA   Opollo Marc S MS   Liu Michelle M   Redd Andrew D AD   Eller Leigh Anne LA   Kityo Cissy C   Kayiwa Joshua J   Laeyendecker Oliver O   Wawer Maria J MJ   Milazzo Mark M   Kiwanuka Noah N   Gray Ronald H RH   Serwadda David D   Sewankambo Nelson K NK   Quinn Thomas C TC   Michael Nelson L NL   Wabwire-Mangen Fred F   Sandberg Johan K JK   Robb Merlin L ML  

The Journal of infectious diseases 20141117 10


<h4>Background</h4>Untreated human immunodeficiency virus type 1 (HIV) infection is associated with persistent immune activation, which is an independent driver of disease progression in European and United States cohorts. In Uganda, HIV-1 subtypes A and D and recombinant AD viruses predominate and exhibit differential rates of disease progression.<h4>Methods</h4>HIV-1 seroconverters (n = 156) from rural Uganda were evaluated to assess the effects of T-cell activation, viral load, and viral subt  ...[more]

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