Magazine article Clinical Psychiatry News

HIV-1 Has Gained Virulence over the Course of Epidemic

Magazine article Clinical Psychiatry News

HIV-1 Has Gained Virulence over the Course of Epidemic

Article excerpt

FROM CROI 2014

Even as antiretroviral therapies began making inroads into the AIDS epidemic, the virulence of HIV-1 increased and the time from seroconversion to a significant CD4-cell drop was cut in half, investigators reported at the Conference on Retroviruses and Opportunistic Infections 2014.

"These results have important public health implications, as higher viremial levels are associated with higher risk of transmission. Based on published formulas, our estimated increase of 0.4 [log.sub.10] copies/mL in viral set point corresponds to a potential 44% increase in transmissibility," Dr. Giota Touloumi of Athens University said in a briefing.

"We all know that the HIV-1 is characterized by huge genetic diversity and different strains of the virus may differ in virulence," said coinvestigator and lead author Dr. Nikos Pantazis, also from Athens University, who presented the data in a plenary session.

In the era before antiretroviral therapy (ART), HIV virulence was measured directly by time to the development of AIDS and death. In the ART era, however, clinicians must rely on marker-based proxies of virulence, such as CD4 seroconversion, CD4 slope (i.e., rate of decline), and viral load set point.

"The picture we have from published research is mixed, with conflicting results, and [some] studies suggest that the HIV virulence has increased, others declare it stable, and others say the virulence is even decreasing," he said.

To see whether the virulence of HIV-1 has changed over the course of the epidemic, the investigators reviewed data from CASCADE, a collaboration between investigators of 26 cohorts of persons with well-estimated dates of HIV seroconversion. …

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