Vernon MOCHACHE, MBChB, MPH,1,* Barbra A. RICHARDSON, PhD,1 Linnet N. MASESE, MBChB, MPH, PhD,1 Susan M. GRAHAM, MD, MPH, PhD,1 Kishorchandra MANDALIYA, MBChB, FRCPath,1 John KINUTHIA, MBChB, MMed, MPH,2,3 Walter JAOKO, MBChB, MTMed, PhD,3 Julie OVERBAUGH, PhD,4 and R. Scott McCLELLAND, MD, MPH1,3
Affiliations
1University of Washington, Seattle, Washington, USA
2Kenyatta National Hospital, Nairobi, Kenya
3University of Nairobi, Nairobi, Kenya
4Fred Hutchison Cancer Research Center, Seattle, Washington, USA
*currently, University of Maryland, Center for International Health, Education and Biosecurity, Nairobi, Kenya
Abstract
Background:
Studies have reported on HIV-infected, antiretroviral therapy (ART)-naïve individuals who show minimal disease progression despite prolonged infection. The characteristics of these long-term non-progressors (LTNPs) are not well-characterized in populations predominantly infected with non-subtype-B HIV-1.
Methods:
Female sex workers in Mombasa, Kenya who acquired HIV-1 were studied to ascertain immunological disease progression. Long-term non-progression was defined as an ART-naïve duration of infection ≥7 years and a majority of CD4+ counts ≥600 cells/µL with a non-declining CD4+ trend. Correlates of long-term non-progression were determined using multivariable logistic regression.
Results:
Between February 1993 and March 2014, 332 women acquired HIV-1. Of these, 77 (23%) had ≥7 years of follow-up and 13 (17%) were categorised as LTNPs. Factors associated with long-term non-progression included age >30 years at infection (aOR=9.41, 95% CI: 1.48–59.86, P=0.005) and nulliparity (aOR=20.19, 95% CI: 1.36–299.90, P=0.03). Each log10 increase in viral set point was associated with a lower likelihood of being a LTNP (aOR=0.31, 95% CI: 0.12–0.79, P=0.01).
Conclusion:
These findings suggest that age and parity may influence the likelihood of long-term non-progression through mechanisms that are not mediated by the effects of these variables on viral load. Future studies should seek to determine whether the associations presented are reproducible.
Keywords: Age, parity, HIV-1, non-subtype B, long-term non-progression, female sex workers, Kenya
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