title: Enrichment of HIV-1 subtype AD recombinants in a Ugandan cohort of severely septic patients.
abstract: BACKGROUND
  Several population-wide HIV-1 subtype distribution studies in Uganda have evaluated relatively healthy clinic patients. Given the differences in HIV-1 disease progression based on subtype, we examined HIV-1 subtype distribution and disease outcomes among hospitalized patients with severe sepsis.
  
  
  METHODS
  Patients with severe sepsis were enrolled at two hospitals in Uganda. Data collected included demographics, Karnofsky scores, highly active antiretroviral therapy (HAART) use, HIV-1 serostatus, CD4+ T cell concentration, whole blood lactate concentration, and blood cultures. HIV-1 subtypes were determined by sequencing parts of the gag and env genes, followed by phylogenetic analysis.
  
  
  RESULTS
  Of the 267 patients evaluated, 228 (85.4%) were HIV infected. The predominant HIV-1 subtypes were A (46%), D (17%), and AD recombinants (30%). HIV-1 subtypes B, C, and other recombinants were uncommon. Patients infected with HIV-1 subtypes A, D and AD viruses were similar in demographics, CD4(+) T cell concentration, HAART use, Karnofsky scores, whole blood lactate concentration, and positive blood cultures. There was no difference in 30-day mortality from severe sepsis between the 3 groups (p = 0.99).
  
  
  CONCLUSIONS
  A high proportion of HIV-1 subtypes A and AD recombinants was observed in this cohort of severely septic patients. The proportion of AD recombinants was higher in this cohort than in previous cohorts of Ugandan HIV-1 patients. No difference in baseline demographics, clinical factors or 30-day mortality was seen across HIV-subtypes.
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America.
authors.forename: Najah I
authors.initials: NI
authors.lastname: Doka
authors.forename: Shevin T
authors.initials: ST
authors.lastname: Jacob
authors.forename: Patrick
authors.initials: P
authors.lastname: Banura
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Moore
authors.forename: David
authors.initials: D
authors.lastname: Meya
authors.forename: Harriet
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: W Michael
authors.initials: WM
authors.lastname: Scheld
authors.forename: Wen
authors.initials: W
authors.lastname: Yuan
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000145:classification* / Q000187:drug effects / Q000235:genetics; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010802:Phylogeny; D015995:Prevalence; D016016:Proportional Hazards Models; D018805:Sepsis / Q000453:epidemiology*; D017422:Sequence Analysis, DNA; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult; D054299:env Gene Products, Human Immunodeficiency Virus / Q000235:genetics; D054301:gag Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D054299:env Gene Products, Human Immunodeficiency Virus; D054301:gag Gene Products, Human Immunodeficiency Virus