Is the virulence of HIV changing? A meta-analysis of trends in prognostic markers of HIV disease progression and transmission.
AIDS
; 26(2): 193-205, 2012 Jan 14.
Article
em En
| MEDLINE
| ID: mdl-22089381
ABSTRACT
OBJECTIVE:
The potential for changing HIV-1 virulence has significant implications for the AIDS epidemic, including changing HIV transmission rates, rapidity of disease progression, and timing of ART. Published data to date have provided conflicting results.DESIGN:
We conducted a meta-analysis of changes in baseline CD4(+) T-cell counts and set point plasma viral RNA load over time in order to establish whether summary trends are consistent with changing HIV-1 virulence.METHODS:
We searched PubMed for studies of trends in HIV-1 prognostic markers of disease progression and supplemented findings with publications referenced in epidemiological or virulence studies. We identified 12 studies of trends in baseline CD4(+) T-cell counts (21,â052 total individuals), and eight studies of trends in set point viral loads (10â,785 total individuals), spanning the years 1984-2010. Using random-effects meta-analysis, we estimated summary effect sizes for trends in HIV-1 plasma viral loads and CD4(+) T-cell counts.RESULTS:
Baseline CD4(+) T-cell counts showed a summary trend of decreasing cell counts [effectâ=â-4.93â cells/µl per year, 95% confidence interval (CI) -6.53 to -3.3]. Set point viral loads showed a summary trend of increasing plasma viral RNA loads (effectâ=â0.013â log(10) âcopies/ml per year, 95% CI -0.001 to 0.03). The trend rates decelerated in recent years for both prognostic markers.CONCLUSION:
Our results are consistent with increased virulence of HIV-1 over the course of the epidemic. Extrapolating over the 30 years since the first description of AIDS, this represents a CD4(+) T cells loss of approximately 148â cells/µl and a gain of 0.39 âlog(10) âcopies/ml of viral RNA measured during early infection. These effect sizes would predict increasing rates of disease progression, and need for ART as well as increasing transmission risk.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
RNA Viral
/
Biomarcadores
/
Infecções por HIV
/
HIV-1
/
Carga Viral
Tipo de estudo:
Prognostic_studies
/
Systematic_reviews
Limite:
Female
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article