Differences in HIV natural history among African and non-African seroconverters in Europe and seroconverters in sub-Saharan Africa

Pantazis, Nikos, Morrison, Charles, Amornkul, Pauli N, Lewden, Charlotte, Salata, Robert A, Minga, Albert, Chipato, Tsungai, Jaffe, Harold, Lakhi, Shabir, Karita, Etienne, Porter, Kholoud, Meyer, Laurence, Touloumi, Giota, Fisher, Martin and on behalf of CASCADE Collaboration in EuroCoord and ANRS 1220 Pr, (2012) Differences in HIV natural history among African and non-African seroconverters in Europe and seroconverters in sub-Saharan Africa. PloS ONE, 7 (3). e32369. ISSN 1932-6203

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Abstract

INTRODUCTION

It is unknown whether HIV treatment guidelines, based on resource-rich country cohorts, are applicable to African populations.

METHODS

We estimated CD4 cell loss in ART-naïve, AIDS-free individuals using mixed models allowing for random intercept and slope, and time from seroconversion to clinical AIDS, death and antiretroviral therapy (ART) initiation by survival methods. Using CASCADE data from 20 European and 3 sub-Saharan African (SSA) cohorts of heterosexually-infected individuals, aged ≥15 years, infected ≥2000, we compared estimates between non-African Europeans, Africans in Europe, and Africans in SSA.

RESULTS

Of 1,959 (913 non-Africans, 302 Europeans-African origin, 744 SSA), two-thirds were female; median age at seroconversion was 31 years. Individuals in SSA progressed faster to clinical AIDS but not to death or non-TB AIDS. They also initiated ART later than Europeans and at lower CD4 cell counts. In adjusted models, Africans (especially from Europe) had lower CD4 counts at seroconversion and slower CD4 decline than non-African Europeans. Median (95% CI) CD4 count at seroconversion for a 15-29 year old woman was 607 (588-627) (non-African European), 469 (442-497) (European-African origin) and 570 (551-589) (SSA) cells/µL with respective CD4 decline during the first 4 years of 259 (228-289), 155 (110-200), and 199 (174-224) cells/µL (p<0.01).

DISCUSSION

Despite differences in CD4 cell count evolution, death and non-TB AIDS rates were similar across study groups. It is therefore prudent to apply current ART guidelines from resource-rich countries to African populations.

Item Type: Article
Additional Information: Martin Fisher is part of the CASCADE Collaboration in EuroCoord and ANRS 1220 Primo-CI Study Group and not one of the principal authors
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health > RA0644 Individual diseases or groups of diseases, A-Z > RA0644.A25 AIDS. HIV infections
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Depositing User: Ellen Thomas
Date Deposited: 23 Dec 2013 13:13
Last Modified: 07 Mar 2017 18:32
URI: http://sro.sussex.ac.uk/id/eprint/47277

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