The rates of HIV superinfection and primary HIV incidence in a general population in Rakai, Uganda.
BACKGROUND
Human immunodeficiency virus (HIV) superinfection has been documented in high-risk individuals; however, the rate of superinfection among HIV-infected individuals within a general population remains unknown.


METHODS
A novel next-generation ultra-deep sequencing technique was utilized to determine the rate of HIV superinfection in a heterosexual population by examining two regions of the viral genome in longitudinal samples from recent HIV seroconverters (n=149) in Rakai District, Uganda.


RESULTS
The rate of superinfection was 1.44 per 100 person years (PYs) (95% confidence interval [CI], .4-2.5) and consisted of both inter- and intrasubtype superinfections. This was compared to primary HIV incidence in 20 220 initially HIV-negative individuals in the general population in Rakai (1.15 per 100 PYs; 95% CI, 1.1-1.2; P= .26). Propensity score matching (PS) was used to control for differences in sociodemographic and behavioral characteristics between the HIV-positive individuals at risk for superinfection and the HIV-negative population at baseline and follow-up. After PS matching, the estimated rate of primary incidence was 3.28 per 100 PYs (95% CI, 2.0-5.3; P = .07) controlling for baseline differences and 2.51 per 100 PYs (95% CI, 1.5-4.3; P = .24) controlling for follow-up differences.


CONCLUSIONS
This suggests that the rate of HIV superinfection in a general population is substantial, which could have a significant impact on future public health and HIV vaccine strategies.
Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, MD 21205, USA. aredd2@jhmi.edu
Andrew D
AD
Redd
Caroline E
CE
Mullis
David
D
Serwadda
Xiangrong
X
Kong
Craig
C
Martens
Stacy M
SM
Ricklefs
Aaron A R
AA
Tobian
Changchang
C
Xiao
Mary K
MK
Grabowski
Fred
F
Nalugoda
Godfrey
G
Kigozi
Oliver
O
Laeyendecker
Joseph
J
Kagaayi
Nelson
N
Sewankambo
Ronald H
RH
Gray
Stephen F
SF
Porcella
Maria J
MJ
Wawer
Thomas C
TC
Quinn
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015163:Superinfection / Q000453:epidemiology* / Q000821:virology*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult