HIV-1 viral control varies by viral subtype in a large cohort of African adults with incident HIV-1 infection.
Price MA., Rida W., Kilembe W., Karita E., Inambao M., Ruzagira E., Kamali A., Sanders EJ., Anzala O., Hunter E., Allen S., Edward VA., Wall KM., Tang J., Fast PE., Kaleebu P., Lakhi S., Mutua G., Bekker LG., Abu-Baker G., Tichacek A., Chetty P., Latka MH., Maenetje P., Makkan H., Kibengo F., Priddy F., Gilmour J.
Few HIV-infected persons can maintain low viral levels without therapeutic intervention. We evaluate predictors of spontaneous viral control in a prospective cohort of African adults shortly after HIV infection. Viral control was defined as ≥2 consecutive VL ≤10,000 copies/mL post-estimated date of infection (EDI) with at least 4 subsequent VL measurements of which at least 75% were ≤ 10,000 in the absence of ART. Multivariable logistic regression characterized predictors of viral control. Of 590 eligible volunteers, 107 (18.1%) experienced viral control of whom 25 (4.2%) maintained VL between 51-2,000 and 5 (0.8%) sustained VL ≤ 50. Median ART free follow-up time was 3.3 years (range: 0.3 to 9.7 years). Factors independently associated with control were HIV-1 subtype A versus C (adjusted odds ratio [aOR]: 2.1 [95%CI: 1.3-3.5]), being female (aOR: 1.8 [1.1-2.8]), and having an HLA class I variant allele B*57 (aOR: 1.9 [1.0-3.6]) in a multivariable model that also controlled for age at time of infection and baseline CD4 T cell count. We observed strong associations between infecting subtype, HLA type, and sex on viral control in this cohort. HIV-1 subtype is important to consider when testing and designing new therapeutic and prevention technologies including vaccines.