title: HIV-1 viral subtype differences in the rate of CD4+ T-cell decline among HIV seroincident antiretroviral naive persons in Rakai district, Uganda.
abstract: BACKGROUND
  Data on the effect of HIV-1 viral subtype on CD4 T-cell decline are limited.
  
  
  METHODS
  We assessed the rate of CD4 T-cell decline per year among 312 HIV seroincident persons infected with different HIV-1 subtypes. Rates of CD4 decline by HIV-1 subtype were determined by linear mixed effects models, using an unstructured convariance structure.
  
  
  RESULTS
  A total of 59.6% had D, 15.7% A, 18.9% recombinant viruses (R), and 5.8% multiple subtypes (M). For all subtypes combined, the overall rate of CD4 T-cell decline was -34.5 [95% confidence interval (CI), -47.1, -22.0] cells/ microL per yr, adjusted for age, sex, baseline CD4 counts, and viral load. Compared with subtype A, the adjusted rate of CD4 cell loss was -73.7/microL/yr (95% CI, -113.5, -33.8, P < 0.001) for subtype D, -43.2/microL/yr (95% CI, -90.2, 3.8, P = 0.072) for recombinants, and -63.9/microL/yr (95% CI, -132.3, 4.4, P = 0.067) for infection with multiple HIV subtypes. Square-root transformation of CD4 cell counts did not change the results.
  
  
  CONCLUSIONS
  Infection with subtype D is associated with significantly faster rates of CD4 T-cell loss than subtype A. This may explain the more rapid disease progression for subtype D compared with subtype A.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. nkiwanuka@rhsp.org
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Merlin
authors.initials: M
authors.lastname: Robb
authors.forename: Oliver
authors.initials: O
authors.lastname: Laeyendecker
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Fredrick E
authors.initials: FE
authors.lastname: Makumbi
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Joseph
authors.initials: J
authors.lastname: Kagaayi
authors.forename: Michael
authors.initials: M
authors.lastname: Eller
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Eller
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000235:genetics* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014454:Uganda; D019562:Viral Load; D055815:Young Adult