title: Rapid disease progression in HIV-1 subtype C-infected South African women.
abstract: BACKGROUND
  Whereas human immunodeficiency virus (HIV) subtype B-infected individuals generally progress to AIDS within 8-10 years, limited data exist for other clades, especially from Africa. We investigated rates of HIV disease progression of clade C-infected South African women.
  
  
  METHODS
  Prospective seroincidence cohorts in KwaZulu-Natal were assessed for acute HIV infection monthly (n = 245) or every 3 months (n = 594) for up to 4 years. Rapid disease progression was defined as CD4 decline to <350 cells/µL by 2 years postinfection. Serial clinical and laboratory assessments were compared using survival analysis and logistic regression models.
  
  
  RESULTS
  Sixty-two women were identified at a median of 42 days postinfection (interquartile range, 34-59), contributing 282 person-years of follow-up. Mean CD4 count dropped by 39.6% at 3 months and 46.7% at 6 months postinfection in women with preinfection measurements. CD4 decline to <350 cells/µL occurred in 31%, 44%, and 55% of women at 1, 2, and 3 years postinfection, respectively, and to <500 cells/µL in 69%, 79%, and 81% at equivalent timepoints. Predictors of rapid progression were CD4 count at 3 months postinfection (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.31-3.28; P = .002), setpoint viral load (HR, 3.82; 95% CI, 1.51-9.67; P = .005), and hepatitis B coinfection (HR, 4.54; 95% CI, 1.31-15.69; P = .017). Conversely, presence of any of HLAB*1302, B*27, B*57, B*5801, or B*8101 alleles predicted non-rapid progression (HR, 0.19; 95% CI, .05-.74; P = .016).
  
  
  CONCLUSIONS
  Nearly half of subtype C-infected women progressed to a CD4 count <350 cells/µL within 2 years of infection. Implementing 2013 World Health Organization treatment guidelines (CD4 count <500 cells/µL) would require most individuals to start antiretroviral therapy within 1 year of HIV infection.
authors.affiliation: Centre for the AIDS Programme of Research in South Africa Department of Medical Microbiology, University of KwaZulu-Natal, Durban National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Koleka
authors.initials: K
authors.lastname: Mlisana
authors.affiliation: Centre for the AIDS Programme of Research in South Africa.
authors.forename: Lise
authors.initials: L
authors.lastname: Werner
authors.affiliation: Centre for the AIDS Programme of Research in South Africa.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Garrett
authors.affiliation: Centre for the AIDS Programme of Research in South Africa.
authors.forename: Lyle R
authors.initials: LR
authors.lastname: McKinnon
authors.affiliation: Centre for the AIDS Programme of Research in South Africa The Global Health Network, Centre for Tropical Medicine, University of Oxford, United Kingdom.
authors.forename: Francois
authors.initials: F
authors.lastname: van Loggerenberg
authors.affiliation: Centre for the AIDS Programme of Research in South Africa National Health Laboratory Service, Johannesburg, South Africa Divisions of Immunology and Medical Virology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town.
authors.forename: Jo-Ann S
authors.initials: JA
authors.lastname: Passmore
authors.affiliation: National Health Laboratory Service, Johannesburg, South Africa Divisions of Immunology and Medical Virology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town.
authors.forename: Clive M
authors.initials: CM
authors.lastname: Gray
authors.affiliation: AIDS Virus Research Unit, National Institute for Communicable Diseases, Johannesburg, South Africa.
authors.forename: Lynn
authors.initials: L
authors.lastname: Morris
authors.affiliation: Centre for the AIDS Programme of Research in South Africa National Health Laboratory Service, Johannesburg, South Africa Divisions of Immunology and Medical Virology, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Williamson
authors.affiliation: Centre for the AIDS Programme of Research in South Africa Columbia University, New York, New York.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Abdool Karim
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000503:physiopathology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D011446:Prospective Studies; D016036:Seroepidemiologic Studies; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D019562:Viral Load; D055815:Young Adult
keywords: HIV disease progression; acute HIV infection; subtype C; viral load; women