Differences in HIV Natural History among African and Non-African Seroconverters in Europe and Seroconverters in Sub-Saharan Africa

PLoS One

Albert Minga¹  Nikos Pantazis²  on behalf of CASCADE Collaboration in EuroCoord and ANRS 1220 Primo-CI Study Group²  Charles Morrison³  Giota Touloumi⁴  Robert A. Salata⁵  Pauli N. Amornkul⁶  Laurence Meyer⁷  Tsungai Chipato⁸  Kholoud Porter⁹  Shabir Lakhi^1,10  Harold Jaffe^1,11  Charlotte Lewden^1,12  Etienne Karita^1,13 

[1] Case Western Reserve University, Cleveland, Ohio, United States of America;Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece;FHI 360, Durham, North Carolina, United States of America;Inserm, U1018, HIV Epidemiology, Université Paris-Sud, AP-HP, Le Kremlin-Bicêtre, France;Inserm, U897, Bordeaux, France;International AIDS Vaccine Initiative (IAVI), San Francisco, California, United States of America;Medical Research Council Clinical Trials Unit, London, United Kingdom;Programme PAC-CI, Abidjan, Côte d'Ivoire;Project San Francisco, Kigali, Rwanda;University of Oxford, Oxford, United Kingdom;University of Zimbabwe, Harare, Zimbabwe;Université Victor Segalen Bordeaux 2, ISPED, Bordeaux, France;Zambia Emory HIV Research Project (ZEHRP), Lusaka, Zambia

关键词: Europe;    AIDS;    African people;    HIV;    Africa;    Tuberculosis;    Cell enumeration techniques;    Medicine and health sciences;   

DOI  :  10.1371/journal.pone.0032369

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

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.

【 授权许可】

CC BY