Disease Progression and Survival with Human Immunodeficiency Virus Type 1 Subtype E Infection among Female Sex Workers in Thailand

Abstract

This study describes rates and correlates of disease progression and survival among 194 female sex workers in northern Thailand who were infected with human immunodeficiency virus type 1 (HIV-1; 96% with subtype E). The median rate of CD4 T lymphocyte decline (3.9 cells/microL/month), median time from infection to <200 CD4 T lymphocytes/microL (6.9 years), and time to 25% mortality (6.0 years) were similar to those found in studies performed in Western countries before highly active antiretroviral therapy was available to populations infected with HIV-1 subtype B. Mortality rates among women with >100,000 HIV-1 RNA copies/mL were 15.4 times higher (95% confidence interval, 5.2-45.2) than among women with <10,000 copies. Initial CD4 T lymphocyte counts and serum virus load were independently strong predictors of survival. These results can help in assessing the effects of the epidemic in Thailand and in determining the prognoses for individual patients.

Higher Set Point Plasma Viral Load and More-Severe Acute HIV Type 1 (HIV-1) Illness Predict Mortality among High-Risk HIV-1-Infected African Women

“…Thus, our findings are generally in agreement with those of the previous studies from both developed and developing world populations, although our survival rates are on the low end of these ranges. Studies among HIV-1-infected female commercial sex workers have suggested more-rapid disease progression [7,33,38], potentially as a result of low socioeconomic status, sexually transmitted diseases, and greater viral genetic diversity [32,39]. Nevertheless, our results do not suggest that the natural history of HIV-1 infection among adults in Africa differs substantially from that observed in the industrialized world in the absence of antiretroviral treatment.…”

“…The largest study of mortality among a seroprevalent HIV-1 cohort from Africa included 197 individuals from rural Malawi and found a median survival duration of 8 years [6]. Studies from other developing countries suggest similar survival; for example, among 194 female sex workers in Thailand, 25% mortality occurred at 6.0 years [33]. Data from industrialized nations from before the introduction of HAART demonstrated 25% mortality at 6-10 years after HIV-1 acquisition [34,35] and median survival duration of 8-13 years [8,36,37].…”

“…The participants were primarily barmaids who generated extra income through sex work and thus may not be completely representative of all women at risk for HIV-1 infection and may have been at risk for faster HIV-1 disease progression [7,33,38]. In addition, because CD4 + cell counts were not introduced in our cohort until 1998, only a subset of women had early CD4 + cell counts.…”

Phase II placebo-controlled study of V-1 Immunitor as a therapeutic modality for treatment of HIV

“…Similarly, the estimated loss in absolute CD4 numbers in placebo group agrees well with published longitudinal surveys in a comparable group of patients who either did not respond to HAART or interrupted their treatment (Palella et al, 2003;Tebas et al, 2002). This estimate is also in agreement with a longitudinal survey of disease progression among non-treated female sex workers in northern Thailand, with median decline of −3.9 CD4 cells/month (Kilmarx et al, 2000). A similar rate of progressive lymphocytopenia equivalent to −3.2 cells/month has been reported among 605 injecting drug users who started with a median 513 CD4 lymphocytes (Lyles et al, 1997).…”

Functional variation of HIV-1 Rev response element in a longitudinally studied cohort

“…The slope was then used to divide the cohort into two groups as faster progressors and slower progressors. We arbitrarily used a CD4 þ count slope of À75 cells/ml/year to separate faster progressors and slower progressors, which is comparable to a median CD4 þ slope in a Thai HIV natural history cohort [Kilmarx et al, 2000]. The slopes of subjects in the two groups are shown in Figure 1.…”