Document Detail


Have the explosive HIV epidemics in sub-Saharan Africa been driven by higher community viral load?
MedLine Citation:
PMID:  23196933     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The HIV epidemic has carved contrasting trajectories around the world with sub-Saharan Africa (SSA) being most affected. We hypothesized that mean HIV-1 plasma RNA viral loads are higher in SSA than other areas, and that these elevated levels may contribute to the scale of epidemics in this region.
DESIGN AND METHODS: To evaluate this hypothesis, we constructed a database of means of 71,668 viral load measurements from 44 cohorts in seven regions of the world. We used linear regression statistical models to estimate differences in viral load between regions. We also constructed and analyzed a mathematical model to describe the impact of the regional viral load differences on HIV epidemic trajectory.
RESULTS: We found substantial regional viral load heterogeneity. The mean viral load in SSA was 0.58 log(10) copies/ml higher than in North America (95% confidence interval 0.45-0.71); this represents about a four-fold increase. The highest mean viral loads were found in Southern and East Africa, whereas in Asia, Europe, North America, and South America, mean viral loads were comparable. Mathematical modeling indicated that conservatively 14% of HIV infections in a representative population in Kenya could be attributed to the enhanced infectiousness of patients with heightened viral load.
CONCLUSION: We conclude that community viral load appears to be higher in SSA than in other regions and this may be a central driver of the massive HIV epidemics in this region. The elevated viral loads in SSA may reflect, among other factors, the high burden of co-infections or the preponderance of HIV-1 subtype C infection.
Authors:
Laith J Abu-Raddad; Ruanne V Barnabas; Holly Janes; Helen A Weiss; James G Kublin; Ira M Longini; Judith N Wasserheit;
Related Documents :
7806953 - Acute miliary blastomycosis in an aids patient.
16868483 - Hemoconcentration and pancreatic necrosis: further defining the relationship.
1909413 - Immunological abnormalities in acute post-transfusion hepatitis non-a non-b.
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AIDS (London, England)     Volume:  27     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-05-24     Completed Date:  2013-10-24     Revised Date:  2014-08-29    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  981-9     Citation Subset:  IM; X    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Africa South of the Sahara / epidemiology
Female
HIV Infections / epidemiology*,  virology*
HIV-1 / isolation & purification*
Humans
Male
Models, Theoretical
Pregnancy
RNA, Viral / blood
Viral Load*
Grant Support
ID/Acronym/Agency:
5 KL2 RR025015/RR/NCRR NIH HHS; AI 38855/AI/NIAID NIH HHS; AI 38858/AI/NIAID NIH HHS; AI 68634/AI/NIAID NIH HHS; AI 68636/AI/NIAID NIH HHS; KL2 TR000421/TR/NCATS NIH HHS; P30 AI027757/AI/NIAID NIH HHS; P30 AI027757/AI/NIAID NIH HHS; U01 AI038855/AI/NIAID NIH HHS; U01 AI068634/AI/NIAID NIH HHS; U01 AI068636/AI/NIAID NIH HHS; UL1 TR000423/TR/NCATS NIH HHS; UM1 AI068634/AI/NIAID NIH HHS; UM1 AI068636/AI/NIAID NIH HHS; UM1 AI106701/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/RNA, Viral
Comments/Corrections
Comment In:
AIDS. 2013 Nov 13;27(17):2825-6   [PMID:  24384633 ]
AIDS. 2013 Sep 24;27(15):2494-6   [PMID:  24029738 ]
AIDS. 2013 Sep 24;27(15):2496-7   [PMID:  24029739 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Transmitted HIV drug resistance in Asia.
Next Document:  Durability of first ART regimen and risk factors for modification, interruption or death in HIV-posi...