HIV subtype study shows need for, benefit of test and treat scale-up

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Measurements of disease progression among South African women who were found to have been recently infected with the same HIV-1 subtype showed faster decline in their immune cell counts than what is considered common, adding impetus to accelerated HIV testing and treatment efforts, according to authors of a study just published in Clinical Infectious Diseases.

While previous studies have indicated that rapid disease progression among people infected with HIV-1 subtype B is rare, with about eight to 10 years before symptoms of AIDS, the authors note, limited data had indicated that disease, and immune cell depletion occurred more rapidly among people with HIV-1 subtype C.

Seeking to add to that data, researchers followed 62 women in KwaZulu-Natal province of South Africa who had been tested regularly for acute HIV-infection, and whose immune cell counts had been measured before they became infected.The women’s infections, with HIV-1 subtype C were discovered at a median estimated 42 days after they became infected. On average, their immune cell, or CD4 counts dropped by nearly 40 percent percent three months after they became infected, and by nearly 50 percent six months after infection. Within two years nearly half of the women had CD4 counts less than 350 cells per cubic liter, well below the current threshold of 500 cells per cubic liter at which the World Health Organization recommends beginning treatment. The authors suggest that subtype C is becoming dominant in the “natural history” of HIV-1 in South Africa and say nearly three-quarters of HIV infected people could reach the World Health Organization threshold of immune cell counts below 500 within a year of infection.

Signs of disturbingly common rapid disease progression in a setting where risks of tuberculosis coinfection are high, the authors conclude, calls for greater effort to accelerate diagnoses of acute HIV infection, and scale-up treatment access.

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