Question
Are reports of a more active HIV true or just scaring people?
18 February 2015. Related: All topics, CD4 and viral load.
Have you seen the news item about a more aggressive form of HIV in Cuba?
Is this factual or is it just scaremongering?
For example at this link:
http://www.mirror.co.uk/news/world-news/aggressive-hiv-strain-turns-aids-5175442
Answer
Thanks for your question.
This is very interesting research, by a leading group of respected researchers.
The group report that people with one strain of HIV all progressed within three years. This definition included having symptoms or a confirmed CD4 count less than 350 cells/mm3. Luckily the full paper is available online, although the study details are quite technical.
As often happens, the study was not always very well reported in the general press. This is a shame as that is all most people see and sometimes the distortions are not helpful.
For example, the article link you included starts with a sentence that does not make sense: i.e. “The CRF19 strain transforms into the full-blown virus considerably faster than the average conversion time of around 10 years”.
This sentence is wrong for many reasons:
- CRF19 is HIV and is not “transforming itself”.
- There is no such things as a “full-blown virus”.
- “Full-blown” is a horrible and inaccurate term was only used in the last century.
- There is no conversion time for the virus because nothing is being converted.
- The average time for HIV to progress in an individual – if this is the intended reference – is more likely to be 3-5 years rather than 10 years.
However, the actual research paper is very well written and the research team are reporting a very careful study. The study is very well reported and Anne-Mieke Vandamme is a leading HIV virologist.
As background, most of the differences in how quickly HIV progresses are related to differences in immune responses rather than different types of virus. However some subtypes of HIV (ie A and D) have been reported to progress a little faster.
This study estimated how quickly HIV progressed in a group of 95 HIV positive people (74 men, 21 women) in Cuba.
The subtypes for the 52 people who progressed more quickly included 9 people with subtype B, 5 with subtype C and 9 with the strain called CRF19. Others had subtypes CRF18, 20, 23 or 24.
People with the other subtypes had greater variability in their responses, with some people not progressing at all. All nine people with CRF19 were faster progressors.
However, an important caution is that this is only nine people and so further research will be important. It is also interesting that the people with this strain didn’t seem to be connected to each other in terms of transmission.
When other factors that affect HIV progression rate were looked at, CRF19 was significant, with a p=values of p=0.042 and p=0.037 (depending on the analysis). This is the multifactorial analysis in Table 3 in the paper.
By comparison, other factors associated with more rapid progression, such as baseline CD4 count, CD4% and viral load results, were much more statistically significant. They had p-values that were less than 0.0001.
For something to be significant, the p-value has to be less than 0.05. The smaller this number the greater the significance.
So by comparison. CRF19 is significant because it is less than 0.05 but the other factors, such as CD4 and viral load were much more significant for predicting faster progression.
The study also reported that the CRF19 strain was more active at replicating in a test tube. This is useful to confirm that the finding may be real, but how this translates into the risk of transmission between people may be very different.
Finally, the clinical implications should really have been discussed.
Although this form of HIV progressed a little faster, there is no suggestion that this reduce the effectiveness of HIV treatment. With other subtypes, people who progress a little quicker than average, still have just as good a response to HIV meds.
This is the information that was also missing in the news reports and is where the concern for scaremongering becomes important. The knock-on effect of scaring people about HIV, in turn adds to stigma and fear we still commonly experience.
In this case, the news reports were looking for quick headlines rather than helpful reporting in context.
The abstract – and very usefully the full text – are at the links below.
Summary abstract:
http://www.ebiomedicine.com/article/S2352-3964(15)00038-9/abstract
Full paper:
http://www.ebiomedicine.com/article/S2352-3964(15)00038-9/fulltext
PDF of full paper:
http://www.ebiomedicine.com/article/S2352-3964(15)00038-9/pdf (PDF)
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