title: Infecting HIV-1 Subtype Predicts Disease Progression in Women of Sub-Saharan Africa.
abstract: BACKGROUND
  Long-term natural history cohorts of HIV-1 in the absence of treatment provide the best measure of virulence by different viral subtypes.
  
  
  METHODS
  Newly HIV infected Ugandan and Zimbabwean women (N=303) were recruited and monitored for clinical, social, behavioral, immunological and viral parameters for 3 to 9.5years.
  
  
  RESULTS
  Ugandan and Zimbabwean women infected with HIV-1 subtype C had 2.5-fold slower rates of CD4 T-cell declines and higher frequencies of long-term non-progression than those infected with subtype A or D (GEE model, P<0.001), a difference not associated with any other clinical parameters. Relative replicative fitness and entry efficiency of HIV-1 variants directly correlated with virulence in the patients, subtype D>A>C (P<0.001, ANOVA).
  
  
  CONCLUSIONS
  HIV-1 subtype C was less virulent than either A or D in humans; the latter being the most virulent. Longer periods of asymptomatic HIV-1 subtype C could explain the continued expansion and dominance of subtype C in the global epidemic.
authors.affiliation: Department of Microbiology and Immunology, Western University, London, ON, Canada.
authors.forename: Colin M
authors.initials: CM
authors.lastname: Venner
authors.affiliation: Joint Clinical Research Centre, Kampala, Uganda; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Immaculate
authors.initials: I
authors.lastname: Nankya
authors.affiliation: Joint Clinical Research Centre, Kampala, Uganda.
authors.forename: Fred
authors.initials: F
authors.lastname: Kyeyune
authors.affiliation: Joint Clinical Research Centre, Kampala, Uganda; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Korey
authors.initials: K
authors.lastname: Demers
authors.affiliation: Family Health International 360, Durham, NC, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kwok
authors.affiliation: Family Health International 360, Durham, NC, USA.
authors.forename: Pai-Lien
authors.initials: PL
authors.lastname: Chen
authors.affiliation: Joint Clinical Research Centre, Kampala, Uganda; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Rwambuya
authors.affiliation: Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Marshall
authors.initials: M
authors.lastname: Munjoma
authors.affiliation: Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe.
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.affiliation: Faculty of Medicine, Makerere University, Kampala, Uganda.
authors.forename: Josaphat
authors.initials: J
authors.lastname: Byamugisha
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Van Der Pol
authors.affiliation: Joint Clinical Research Centre, Kampala, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Mugyenyi
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Salata
authors.affiliation: Family Health International 360, Durham, NC, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Morrison
authors.affiliation: Department of Microbiology and Immunology, Western University, London, ON, Canada; Joint Clinical Research Centre, Kampala, Uganda; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA. Electronic address: earts@uwo.ca.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Arts
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology / Q000821:virology; D045744:Cell Line, Tumor; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D056084:Genetic Fitness; D014644:Genetic Variation; D005838:Genotype; D005843:Geography; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000145:classification* / Q000235:genetics* / Q000276:immunology; D006801:Humans; D019562:Viral Load; D014779:Virus Replication
keywords: Africa; Disease progression; HIV-1 diversity; Pathogenesis; Subtypes