Mariya V Sivay1, Jessica M Fogel1, Jing Wang2, Yinfeng Zhang1, Estelle Piwowar-Manning1, William Clarke1, Autumn Breaud1, Joel Blankson3, Erica L Hamilton4, Kathleen Kahn5, Amanda Selin6, F Xavier Gomez-Olive5, Catherine MacPhail5,7, James P Hughes8, Audrey Pettifor5,9, Susan H Eshleman1. 1. a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA. 2. b Statistical Center for HIV/ AIDS Research & Prevention (SCHARP) , Seattle , Washington , USA. 3. c Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , USA. 4. d Science Facilitation Department , FHI 360 , Durham , North Carolina , USA. 5. e MRC/Wits Rural Public Health and Health, Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa. 6. f University of North Carolina at Chapel Hill, Carolina Population Center , Chapel Hill , North Carolina , USA. 7. g School of Health and Society , University of Wollongong , Wollongong , Australia. 8. h Department of Biostatistics , University of Washington , Seattle , Washington , USA. 9. i Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.
Abstract
BACKGROUND: Some individuals control HIV replication without antiretroviral (ARV) therapy. OBJECTIVE: To analyze viral suppression in young women in rural South Africa enrolled in a trial evaluating a behavioral intervention for HIV prevention. METHODS: Plasma samples were obtained from women ages 13-24 (81 infected at enrollment, 164 seroconverters). ARV testing was performed using an assay that detects 20 ARV drugs. Women were classified as viremic controllers if they were virally suppressed for ≥12 months with no ARV drug use. RESULTS: Samples from 216/245 (88.2%) women had no ARV drugs detected at their first HIV-positive visit. Thirty-four (15.7%) of the 216 women had a viral load <2,000 copies/mL. Fifteen of the 34 women were followed for ≥12 months; 12 were virally suppressed with no ARV drugs detected during follow-up. These women were classified as viremic controllers (overall: 12/216 = 5.6%). The median CD4 cell count at the first HIV-positive visit was higher among the 12 controllers than among the 204 women who were not using ARV drugs (759 vs. 549 cells/mm3, p = 0.02). Some women had a viral load <40 copies/mL at a single study visit, but none were classified as elite controllers (viral load <40 copies/mL for ≥12 months with no ARV drug use). CONCLUSIONS: In this cohort, 5.6% of women who were not using ARV drugs had sustained viral suppression. This represents a minimum estimate of the frequency of viremic controllers in this cohort, since some women were not followed long enough to meet the criteria for classification.
BACKGROUND: Some individuals control HIV replication without antiretroviral (ARV) therapy. OBJECTIVE: To analyze viral suppression in young women in rural South Africa enrolled in a trial evaluating a behavioral intervention for HIV prevention. METHODS: Plasma samples were obtained from women ages 13-24 (81 infected at enrollment, 164 seroconverters). ARV testing was performed using an assay that detects 20 ARV drugs. Women were classified as viremic controllers if they were virally suppressed for ≥12 months with no ARV drug use. RESULTS: Samples from 216/245 (88.2%) women had no ARV drugs detected at their first HIV-positive visit. Thirty-four (15.7%) of the 216 women had a viral load <2,000 copies/mL. Fifteen of the 34 women were followed for ≥12 months; 12 were virally suppressed with no ARV drugs detected during follow-up. These women were classified as viremic controllers (overall: 12/216 = 5.6%). The median CD4 cell count at the first HIV-positive visit was higher among the 12 controllers than among the 204 women who were not using ARV drugs (759 vs. 549 cells/mm3, p = 0.02). Some women had a viral load <40 copies/mL at a single study visit, but none were classified as elite controllers (viral load <40 copies/mL for ≥12 months with no ARV drug use). CONCLUSIONS: In this cohort, 5.6% of women who were not using ARV drugs had sustained viral suppression. This represents a minimum estimate of the frequency of viremic controllers in this cohort, since some women were not followed long enough to meet the criteria for classification.
Entities:
Keywords:
HIV; Natural control; South Africa; Viremic controllers; Young women
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