journal.pone.0032369.pdf (241.81 kB)
Differences in HIV natural history among African and non-African seroconverters in Europe and seroconverters in sub-Saharan Africa
journal contribution
posted on 2023-06-08, 16:33 authored by Nikos Pantazis, Charles Morrison, Pauli N Amornkul, Charlotte Lewden, Robert A Salata, Albert Minga, Tsungai Chipato, Harold Jaffe, Shabir Lakhi, Etienne Karita, Kholoud Porter, Laurence Meyer, Giota Touloumi, Martin Fisher, on behalf of CASCADE Collaboration in EuroCoord and ANRS 1220 PrINTRODUCTION 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.
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- Published
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- Published version
Journal
PLoS ONEISSN
1932-6203Publisher
Public Library of ScienceExternal DOI
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3Volume
7Article number
e32369Department affiliated with
- BSMS Publications
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Martin Fisher is part of the CASCADE Collaboration in EuroCoord and ANRS 1220 Primo-CI Study Group and not one of the principal authorsFull text available
- Yes
Peer reviewed?
- Yes
Legacy Posted Date
2013-12-23First Open Access (FOA) Date
2013-12-23First Compliant Deposit (FCD) Date
2013-12-23Usage metrics
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