Natural history of HIV-control since seroconversion.
AIDS
; 27(15): 2451-60, 2013 Sep 24.
Article
en En
| MEDLINE
| ID: mdl-23912979
ABSTRACT
OBJECTIVES:
HIV-controllers spontaneously maintain HIV viremia at an undetectable level. We aimed to describe the delay to control from seroconversion, the duration of control, and risk factors for losing control.METHODS:
HIV-controllers were identified from a pooled dataset of 24 seroconverter cohorts from Europe, Australia, and Canada (CASCADE). HIV-controllers had at least five consecutive viral loads less than 400/500 copies/ml, while antiretroviral therapy naive, for at least 5 years after seroconversion. End of control was defined as two consecutive viral loads above 2000 copies/ml. Duration of control was described using Kaplan-Meier estimates; factors associated with duration of control were identified using a Cox model. CD4⺠cell count evolution during control was described using a mixed model.RESULTS:
Of 9896 eligible seroconverters, we identified 140 (1.4%) HIV-controllers, the largest database of HIV-controllers followed from seroconversion. For 64 with viral load measured within 24 months from seroconversion, median delay to control was 16.7 (interquartile range 7.8-37.9) months. Probability of maintaining control 20 years after seroconversion was 0.74 [95% confidence interval (CI) 0.64-0.85]. Occurrence of blips followed by return to undetectability did not increase the risk of loss of control [hazard ratio 0.81 (95% CI 0.10-6.70)]. However, CD4⺠cell loss during control was significantly accelerated in individuals with blips.CONCLUSION:
In most individuals, control occurred rapidly after seroconversion; however, more than 3 years were required to achieve control in 25% of HIV-controllers. Control may be sustained even when CD4⺠cell levels are below 500 cells/µl, opening important new perspectives to understand the physiopathology underlying control.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Viremia
/
Infecciones por VIH
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VIH-1
/
Seropositividad para VIH
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
País/Región como asunto:
America do norte
/
Europa
/
Oceania
Idioma:
En
Año:
2013
Tipo del documento:
Article