Lower prevalence and incidence of HIV-1 syncytium-inducing phenotype among injecting drug users compared with homosexual men.

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Lower prevalence and incidence of HIV-1 syncytium-inducing phenotype among injecting drug users compared with homosexual men.

AIDS. 1995 Sep;9(9):1085-92. Unique Identifier : AIDSLINE MED/96085726
Spijkerman IJ; Koot M; Prins M; Keet IP; van den Hoek AJ; Miedema F; Coutinho RA; Department of Public Health and Environment, Municipal Health; Service, Amsterdam, The Netherlands.

Abstract: OBJECTIVE: To study the prevalence, incidence and predictive value for progression to AIDS of the HIV-1 syncytium-inducing (SI) phenotype in HIV-infected injecting drug users (IDU) compared with HIV-infected homosexual men. DESIGN: Two prospective cohort studies on HIV-1 infection among IDU and homosexual men. METHODS: HIV-infected IDU (n = 225) and homosexual men (n = 366) without AIDS were studied from March 1989 through December 1993. Data on laboratory markers, including the presence of SI variants, demographics, behavioural characteristics and clinical events were collected at every visit. RESULTS: At baseline, SI variants were detected in 4% of IDU and 17% of homosexual men. During the study period 18 IDU and 68 homosexual men switched from non-SI to SI phenotype (4-year cumulative incidence, 14.6 and 28.4%, respectively) before AIDS diagnosis. Among participants with a documented date of HIV infection the cumulative incidence of SI was lower among IDU than homosexual men (4-year cumulative incidence, 6.2 and 20.7%, respectively). At AIDS diagnosis, 21% of all AIDS cases among IDU had the SI phenotype compared with 54% among homosexual men. In both risk groups an accelerated CD4 decline was found after the non-SI-to-SI switch. The SI phenotype appeared to be a predictor of AIDS (multivariate relative hazard, 5.33), independent of CD4 cell count and p24 antigen at baseline. In the multivariate time-dependent analysis, the relative hazard of SI phenotype decreased considerably, which is consistent with the hypothesis that the effect of SI phenotype on progression to AIDS is mediated by CD4 cell count. CONCLUSION: The SI phenotype is associated with accelerated CD4 decline and progression to AIDS in both risk groups. The remarkable lower prevalence and incidence of the SI phenotype among IDU may implicate a difference in pathogenesis and natural history of HIV infection linked to transmission group.

Keywords: Adult Cohort Studies CD4 Lymphocyte Count Female Follow-Up Studies Gene Expression Regulation, Viral/PHYSIOLOGY Giant Cells/IMMUNOLOGY/*VIROLOGY *Homosexuality, Male Human HIV Seropositivity/IMMUNOLOGY/*TRANSMISSION/VIROLOGY HIV-1/*GENETICS Male *Phenotype Prognosis Substance Abuse, Intravenous/IMMUNOLOGY/*VIROLOGY JOURNAL ARTICLE
960430
M9640862

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