RT Journal Article
SR Electronic
T1 The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian−European collaborative retrospective cohort study
JF CMAJ Open
FD Canadian Medical Association
SP E318
OP E329
DO 10.9778/cmajo.20140017
VO 2
IS 4
A1 Klein, Marina B.
A1 Young, Jim
A1 Dunn, David
A1 Ledergerber, Bruno
A1 Sabin, Caroline
A1 Cozzi-Lepri, Alessandro
A1 Dabis, Francois
A1 Harrigan, Richard
A1 Tan, Darrell H.
A1 Walmsley, Sharon
A1 Gill, John
A1 Cooper, Curtis
A1 Scherrer, Alexandra U.
A1 Mocroft, Amanda
A1 Hogg, Robert S.
A1 Smaill, Fiona
A1 ,
YR 2014
UL http://www.cmajopen.ca/content/2/4/E318.abstract
AB Background Ethnic differences have the potential to confound associations between HIV-1 subtype and immunologic progression. We compared declines in CD4 cell counts during untreated infection for the most prevalent HIV-1 subtypes, focusing on distinguishing between the effects of viral subtype and ethnicity. Methods We combined data from 4 European and 6 Canadian cohorts, selecting adults in the stable chronic phase of untreated HIV infection. We estimated the change in square root CD4 cell count over time for subtypes and ethnicities using mixed models, adjusting for covariates selected for their potential effect on initial CD4 cell count or its decline. Results Data from 9772 patients were analyzed, contributing 79 175 measurements of CD4 cell count and 24 157 person-years of follow-up. Overall, there were no appreciable differences in CD4 cell count decline for viral subtypes A, CRF01_AE, CRF02_AG, C and G compared with viral subtype B; whereas the decline in CD4 cell count in patients of African ancestry was considerably slower than in patients of other ethnicity. When ethnic groups were studied separately, there was evidence for slower declines in CD4 cell count in viral subtypes C, and possibly A and G, compared with viral subtype B in patients of African ancestry but not among patients of other ethnicities, suggesting an interaction between subtype and ethnicity. Interpretation Ethnicity is a major determinant of CD4 cell count decline; viral subtype differences may have existed but were small compared with the effect of ethnicity and were most apparent in patients of African ancestry. In developing countries, slower CD4 cell count declines among individuals of African descent may translate to a longer asymptomatic phase and increase the opportunity for HIV transmission.