HIV-1 viral subtype differences in the rate of CD4+ T-cell decline among HIV seroincident antiretroviral naive persons in Rakai district, Uganda

J Acquir Immune Defic Syndr. 2010 Jun;54(2):180-4. doi: 10.1097/QAI.0b013e3181c98fc0.


Background: Data on the effect of HIV-1 viral subtype on CD4 T-cell decline are limited.

Methods: We assessed the rate of CD4 T-cell decline per year among 312 HIV seroincident persons infected with different HIV-1 subtypes. Rates of CD4 decline by HIV-1 subtype were determined by linear mixed effects models, using an unstructured convariance structure.

Results: A total of 59.6% had D, 15.7% A, 18.9% recombinant viruses (R), and 5.8% multiple subtypes (M). For all subtypes combined, the overall rate of CD4 T-cell decline was -34.5 [95% confidence interval (CI), -47.1, -22.0] cells/ microL per yr, adjusted for age, sex, baseline CD4 counts, and viral load. Compared with subtype A, the adjusted rate of CD4 cell loss was -73.7/microL/yr (95% CI, -113.5, -33.8, P < 0.001) for subtype D, -43.2/microL/yr (95% CI, -90.2, 3.8, P = 0.072) for recombinants, and -63.9/microL/yr (95% CI, -132.3, 4.4, P = 0.067) for infection with multiple HIV subtypes. Square-root transformation of CD4 cell counts did not change the results.

Conclusions: Infection with subtype D is associated with significantly faster rates of CD4 T-cell loss than subtype A. This may explain the more rapid disease progression for subtype D compared with subtype A.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • CD4 Lymphocyte Count*
  • Disease Progression
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • HIV Infections / immunology
  • HIV Infections / virology*
  • HIV-1 / genetics*
  • HIV-1 / pathogenicity
  • Humans
  • Male
  • Middle Aged
  • Sex Factors
  • Uganda
  • Viral Load
  • Young Adult