Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART)
Abstract Introduction HIV controllers have low viral loads (VL) without antiretroviral treatment (ART). We evaluated viraemic control in a community‐randomized trial conducted in Zambia and South Africa that evaluated the impact of a combination prevention intervention on HIV incidence (HPTN 071 [Po...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Journal of the International AIDS Society |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/jia2.26179 |
| _version_ | 1797646937439076352 |
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| author | Wendy Grant‐McAuley Estelle Piwowar‐Manning William Clarke Autumn Breaud Kidist Belay Zewdie Ayana Moore Helen Mary Ayles Barry Kosloff Kwame Shanaube Peter Bock Sue‐Ann Meehan Gerald Maarman Sarah Fidler Richard Hayes Deborah Donnell Susan H. Eshleman for the HPTN 071 (PopART) Study Team |
| author_facet | Wendy Grant‐McAuley Estelle Piwowar‐Manning William Clarke Autumn Breaud Kidist Belay Zewdie Ayana Moore Helen Mary Ayles Barry Kosloff Kwame Shanaube Peter Bock Sue‐Ann Meehan Gerald Maarman Sarah Fidler Richard Hayes Deborah Donnell Susan H. Eshleman for the HPTN 071 (PopART) Study Team |
| author_sort | Wendy Grant‐McAuley |
| collection | DOAJ |
| description | Abstract Introduction HIV controllers have low viral loads (VL) without antiretroviral treatment (ART). We evaluated viraemic control in a community‐randomized trial conducted in Zambia and South Africa that evaluated the impact of a combination prevention intervention on HIV incidence (HPTN 071 [PopART]; 2013–2018). Methods VL and antiretroviral (ARV) drug testing were performed using plasma samples collected 2 years after enrolment for 4072 participants who were HIV positive at the start of the study intervention. ARV drug use was assessed using a qualitative laboratory assay that detects 22 ARV drugs in five drug classes. Participants were classified as non‐controllers if they had a VL ≥2000 copies/ml with no ARV drugs detected at this visit. Additional VL and ARV drug testing was performed at a second annual study visit to confirm controller status. Participants were classified as controllers if they had VLs <2000 with no ARV drugs detected at both visits. Non‐controllers who had ARV drugs detected at either visit were excluded from the analysis to minimize potential confounders associated with ARV drug access and uptake. Results The final cohort included 126 viraemic controllers and 766 non‐controllers who had no ARV drugs detected. The prevalence of controllers among the 4072 persons assessed was 3.1% (95% confidence interval [CI]: 2.6%, 3.6%). This should be considered a minimum estimate, since high rates of ARV drug use in the parent study limited the ability to identify controllers. Among the 892 participants in the final cohort, controller status was associated with biological sex (female > male, p = 0.027). There was no significant association between controller status and age, study country or herpes simplex virus type 2 (HSV‐2) status at study enrolment. Conclusions To our knowledge, this report presents the first large‐scale, population‐level study evaluating the prevalence of viraemic control and associated factors in Africa. A key advantage of this study was that a biomedical assessment was used to assess ARV drug use (vs. self‐reported data). This study identified a large cohort of HIV controllers and non‐controllers not taking ARV drugs, providing a unique repository of longitudinal samples for additional research. This cohort may be useful for further studies investigating the mechanisms of virologic control. |
| first_indexed | 2024-03-11T15:09:08Z |
| format | Article |
| id | doaj.art-b2c0c8c3efe346ffbdaed8b6335fa7d5 |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-03-11T15:09:08Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-b2c0c8c3efe346ffbdaed8b6335fa7d52023-10-30T01:48:30ZengWileyJournal of the International AIDS Society1758-26522023-10-012610n/an/a10.1002/jia2.26179Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART)Wendy Grant‐McAuley0Estelle Piwowar‐Manning1William Clarke2Autumn Breaud3Kidist Belay Zewdie4Ayana Moore5Helen Mary Ayles6Barry Kosloff7Kwame Shanaube8Peter Bock9Sue‐Ann Meehan10Gerald Maarman11Sarah Fidler12Richard Hayes13Deborah Donnell14Susan H. Eshleman15for the HPTN 071 (PopART) Study Team16Department of Pathology Johns Hopkins University School of Medicine Baltimore Maryland USADepartment of Pathology Johns Hopkins University School of Medicine Baltimore Maryland USADepartment of Pathology Johns Hopkins University School of Medicine Baltimore Maryland USADepartment of Pathology Johns Hopkins University School of Medicine Baltimore Maryland USADepartment of Epidemiology University of Washington Seattle Washington USAFHI 360 Durham North Carolina USAZambart University of Zambia School of Public Health Lusaka ZambiaZambart University of Zambia School of Public Health Lusaka ZambiaZambart University of Zambia School of Public Health Lusaka ZambiaDesmond Tutu TB Center Department of Paediatrics and Child Health Stellenbosch University Western Cape South AfricaDesmond Tutu TB Center Department of Paediatrics and Child Health Stellenbosch University Western Cape South AfricaCentre for Cardio‐Metabolic Research in Africa Division of Medical Physiology Faculty of Medicine and Health Sciences Stellenbosch University Western Cape South AfricaDepartment of Infectious Disease Imperial College London London UKDepartment of Infectious Disease Epidemiology London School of Hygiene and Tropical Medicine London UKFred Hutchinson Cancer Research Center Seattle Washington USADepartment of Pathology Johns Hopkins University School of Medicine Baltimore Maryland USADepartment of Pathology Johns Hopkins University School of Medicine Baltimore Maryland USAAbstract Introduction HIV controllers have low viral loads (VL) without antiretroviral treatment (ART). We evaluated viraemic control in a community‐randomized trial conducted in Zambia and South Africa that evaluated the impact of a combination prevention intervention on HIV incidence (HPTN 071 [PopART]; 2013–2018). Methods VL and antiretroviral (ARV) drug testing were performed using plasma samples collected 2 years after enrolment for 4072 participants who were HIV positive at the start of the study intervention. ARV drug use was assessed using a qualitative laboratory assay that detects 22 ARV drugs in five drug classes. Participants were classified as non‐controllers if they had a VL ≥2000 copies/ml with no ARV drugs detected at this visit. Additional VL and ARV drug testing was performed at a second annual study visit to confirm controller status. Participants were classified as controllers if they had VLs <2000 with no ARV drugs detected at both visits. Non‐controllers who had ARV drugs detected at either visit were excluded from the analysis to minimize potential confounders associated with ARV drug access and uptake. Results The final cohort included 126 viraemic controllers and 766 non‐controllers who had no ARV drugs detected. The prevalence of controllers among the 4072 persons assessed was 3.1% (95% confidence interval [CI]: 2.6%, 3.6%). This should be considered a minimum estimate, since high rates of ARV drug use in the parent study limited the ability to identify controllers. Among the 892 participants in the final cohort, controller status was associated with biological sex (female > male, p = 0.027). There was no significant association between controller status and age, study country or herpes simplex virus type 2 (HSV‐2) status at study enrolment. Conclusions To our knowledge, this report presents the first large‐scale, population‐level study evaluating the prevalence of viraemic control and associated factors in Africa. A key advantage of this study was that a biomedical assessment was used to assess ARV drug use (vs. self‐reported data). This study identified a large cohort of HIV controllers and non‐controllers not taking ARV drugs, providing a unique repository of longitudinal samples for additional research. This cohort may be useful for further studies investigating the mechanisms of virologic control.https://doi.org/10.1002/jia2.26179HIVcontrollerpopulationHPTN 071ZambiaSouth Africa |
| spellingShingle | Wendy Grant‐McAuley Estelle Piwowar‐Manning William Clarke Autumn Breaud Kidist Belay Zewdie Ayana Moore Helen Mary Ayles Barry Kosloff Kwame Shanaube Peter Bock Sue‐Ann Meehan Gerald Maarman Sarah Fidler Richard Hayes Deborah Donnell Susan H. Eshleman for the HPTN 071 (PopART) Study Team Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART) Journal of the International AIDS Society HIV controller population HPTN 071 Zambia South Africa |
| title | Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART) |
| title_full | Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART) |
| title_fullStr | Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART) |
| title_full_unstemmed | Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART) |
| title_short | Population‐level analysis of natural control of HIV infection in Zambia and South Africa: HPTN 071 (PopART) |
| title_sort | population level analysis of natural control of hiv infection in zambia and south africa hptn 071 popart |
| topic | HIV controller population HPTN 071 Zambia South Africa |
| url | https://doi.org/10.1002/jia2.26179 |
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