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Demographics and natural history of HIV-1-infected spontaneous controllers of viremia: extremes on a continuum.

Demographics and natural history of HIV-1-infected spontaneous controllers of viremia: extremes on a continuum.
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Yang OO, Cumberland WG, Escobar R, Liao D, Chew KW,


Yang OO, Cumberland WG, Escobar R, Liao D, Chew KW, (click to view)

Yang OO, Cumberland WG, Escobar R, Liao D, Chew KW,

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AIDS (London, England) 2017 03 15() doi 10.1097/QAD.0000000000001443

Abstract
OBJECTIVES
HIV-1-infected persons spontaneously controlling viremia without treatment (SCV) are rare. Gender and race effects on prevalence and outcome are poorly defined, and it is unclear whether SCV qualitatively or quantitatively differs from typical infection. These issues are examined.

DESIGN
Medical records of 46 524 persons receiving outpatient care for HIV-1 infection were reviewed. Of these, 29 811 had adequate viremia testing for SCV screening.

METHODS
SCV was defined as ≥3 consecutive plasma viremia measurements <50 RNA copies/mL spanning ≥1 year without treatment. SCV loss was defined as ≥3 consecutive viremia measurements ≥50 or one ≥1000. Demographics of persons with SCV were compared to the total population. Viremia and blood CD4 T cell levels during SCV were compared between demographic subgroups and persons who maintained or lost SCV during observation. RESULTS
53 persons (0.18%) met SCV criteria. Prevalence was higher for women versus men and Blacks versus Whites; these appeared independent. Loss of SCV was observed at 1.22%/year, and significantly associated with viremia ‘blips.’ Blip magnitudes fit log-normal distributions with means below 50 RNA copies/mL.

CONCLUSIONS
Our novel observation of higher SCV prevalence in women and Blacks is consistent with prior studies of typical chronic infection. Viremia blips correspond to greater risk of loss of SCV, likely reflecting higher set-point viremia under the limit of detection. Our findings suggest that SCV represents an extreme along a continuum of HIV-1 infection, and not qualitative difference.

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