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In Uganda, MHRP Researchers Find Viral Burden to be Primary Predictor of HIV Disease Progression
New findings published this week in the Journal of Infectious Diseases found HIV-1 viral load and subtype to be the primary predictors of disease progression in rural Uganda.
The findings from the collaborative study, lead by researchers at the U.S. Military HIV Research Program (MHRP), is contrary to current understanding that T-cell activation predicts disease progression independently of viral load. Although T-cell immune activation is strongly associated with disease progression in HIV subtype B infections, this study suggests that viral replication is the primary driver of HIV disease in Uganda where subtype A, D, and D containing recombinants circulate.
Michael Eller, Ph. D., lead researcher in the study, said the results reiterate that HIV pathogenesis may be different in the African context.
“These results are important because more than two-thirds of global infections occur in Africa. We need more studies that characterize what untreated disease looks like in an African setting.” Eller said.
“There are numerous factors that differ between the African and US or European settings, such as environmental factors, other infections, nutrition, host immunogenetics, HIV viral subtype, predominant mode of transmission, as well as access to treatment.“
The study followed 156 HIV infected volunteers identified by the Rakai Community Cohort Study (RCCS) in rural Uganda, where subtypes A, D, and recombinant AD are most common. Researchers tracked the effects of T-cell activation, viral load, and viral subtype on disease progression during clinical follow up.
“Our study emphasizes that we need to continue to study HIV immunopathogenesis in the parts of the world where most cases of HIV infection occur, and we cannot assume that relationships that are true in Western cohorts directly apply to the African setting,” said Karolinska Intitutet Professor Johan Sandberg, who collaborated on the study.
This study was performed by the U.S. Military HIV Research Program, Walter Reed Army Institute of Research in collaboration with the Makerere University Walter Reed Project, Johns Hopkins University Bloomberg School of Public Health, National Institute of Allergy and Infectious Diseases (NIH), Makerere University College of Health Sciences, Rakai Health Sciences Program, and the Center for Infectious Medicine, Karolinska Institutet.