HIV-1 viral control varies by viral subtype in a large cohort of African adults with incident HIV-1 infection
Few HIV-infected persons can maintain low viral levels without therapeutic intervention. We evaluate predictors of spontaneous viral control in a prospective cohort of African adults shortly after HIV infection. Viral control was defined as ≥2 consecutive VL ≤10,000 copies/mL post-estimated date of infection (EDI) with at least 4 subsequent VL measurements of which at least 75% were ≤ 10,000 in the absence of ART. Multivariable logistic regression characterized predictors of viral control. Of 590 eligible volunteers, 107 (18.1%) experienced viral control of whom 25 (4.2%) maintained VL between 51-2,000 and 5 (0.8%) sustained VL ≤ 50. Median ART free follow-up time was 3.3 years (range: 0.3 to 9.7 years). Factors independently associated with control were HIV-1 subtype A versus C (adjusted odds ratio [aOR]: 2.1 [95%CI: 1.3-3.5]), being female (aOR: 1.8 [1.1-2.8]), and having an HLA class I variant allele B*57 (aOR: 1.9 [1.0-3.6]) in a multivariable model that also controlled for age at time of infection and baseline CD4 T cell count. We observed strong associations between infecting subtype, HLA type, and sex on viral control in this cohort. HIV-1 subtype is important to consider when testing and designing new therapeutic and prevention technologies including vaccines.