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. 2012;7(10):e48356.
doi: 10.1371/journal.pone.0048356. Epub 2012 Oct 29.

Enrichment of HIV-1 subtype AD recombinants in a Ugandan cohort of severely septic patients

Najah I Doka  1 , Shevin T Jacob, Patrick Banura, Christopher C Moore, David Meya, Harriet Mayanja-Kizza, Steven J Reynolds, W Michael Scheld, Wen Yuan
Affiliations

Enrichment of HIV-1 subtype AD recombinants in a Ugandan cohort of severely septic patients

Najah I Doka et al. PLoS One. 2012.

Abstract

Background: Several population-wide HIV-1 subtype distribution studies in Uganda have evaluated relatively healthy clinic patients. Given the differences in HIV-1 disease progression based on subtype, we examined HIV-1 subtype distribution and disease outcomes among hospitalized patients with severe sepsis.

Methods: Patients with severe sepsis were enrolled at two hospitals in Uganda. Data collected included demographics, Karnofsky scores, highly active antiretroviral therapy (HAART) use, HIV-1 serostatus, CD4+ T cell concentration, whole blood lactate concentration, and blood cultures. HIV-1 subtypes were determined by sequencing parts of the gag and env genes, followed by phylogenetic analysis.

Results: Of the 267 patients evaluated, 228 (85.4%) were HIV infected. The predominant HIV-1 subtypes were A (46%), D (17%), and AD recombinants (30%). HIV-1 subtypes B, C, and other recombinants were uncommon. Patients infected with HIV-1 subtypes A, D and AD viruses were similar in demographics, CD4(+) T cell concentration, HAART use, Karnofsky scores, whole blood lactate concentration, and positive blood cultures. There was no difference in 30-day mortality from severe sepsis between the 3 groups (p = 0.99).

Conclusion: A high proportion of HIV-1 subtypes A and AD recombinants was observed in this cohort of severely septic patients. The proportion of AD recombinants was higher in this cohort than in previous cohorts of Ugandan HIV-1 patients. No difference in baseline demographics, clinical factors or 30-day mortality was seen across HIV-subtypes.

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Conflict of interest statement

Competing Interests: The authors have the following interest. This work was partly supported by the Pfizer Initiative in International Health at the University of Virginia [GA 9001SZ]. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1
Figure 1. Enrollment procedure.
Figure 2
Figure 2. Distribution of HIV-1 subtypes among patients with severe sepsis.
Subtype A (n = 81), D (n = 29), AD (n = 53), C (n = 3), AC (n = 2), AB (n = 2), BD (n = 3), CD (n = 2).
Figure 3
Figure 3. K-M survival curves comparing mortality between HIV-1 subtypes A vs. D vs. AD recombinants.
See this image and copyright information in PMC

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