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HIV virulence increased through epidemic until plateau in 2000

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BOSTON — Data presented here at the 2014 Conference on Retroviruses and Opportunistic Infections suggest that the virulence of HIV infection increased throughout the epidemic, but plateaued starting in about 2000.

“In the pre-ART era, HIV virulence was assessed by the AIDS-related events,” Giota Touloumi, PhD, associate professor at Athens University Medical School in Greece, said during a presentation. “Fortunately in the current era, AIDS-related events have drastically decreased, and we have to use surrogate markers to assess the virulence, such as CD4 cell counts and viral load, in particular, the set point viral load, which is the minimum viral load after the initial surge in viremia. This occurs approximately 1 year after seroconversion.”

 

Giota Touloumi

Touloumi and colleagues used data from the CASCADE collaboration of HIV cohorts with well estimated dates of seroconverion to assess virulence and transmissibility of HIV among 15,875 individuals who seroconverted from 1979 to 2008. The study excluded African cohorts, people who seroconverted in 2009 or later and children younger than 15 years at time of seroconversion. The researchers evaluated the surrogate markers for virulence in this cohort, including CD4 cell counts and viral load measurements.

In the early 1980s, the CD4 cell count for a typical individual at seroconversion was approximately 770 cells/mcL. This declined to a CD4 count of approximately 570 cells/mcL in 2000, and has remained at a plateau since. In 1980, the estimated set-point viral load was 4.05 log₁₀ copies/mL, compared with 4.5 log₁₀ copies/mL in 2002. After 2002, the viral load tended to return to lower levels.

“Based on published formulas, our estimated increase of 0.45 log₁₀ in set-point viral load corresponds to a 44% increase in transmissibility,” Touloumi said. “Our results provide strong indications of an increased HIV-1 virulence and transmissibility during the course of the epidemic and a potential plateau effect after 2000.”

Disclosures: Touloumi reports no relevant financial disclosures.

For more information:

Pantazis N. Abstract #36. Presented at: 2014 CROI; March 3-6; Boston.