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HIV Disease Progression

Researchers May Have Caught HIV Becoming More Virulent in Cuba

A study from Cuba, recently published online in EBioMedicine, has generated wide media interest because researchers have identified a particular variety of the virus, dubbed CRF19_cpx, that is associated with rapid post-diagnosis drops in CD4 T-cell count and progression to AIDS. In the study, all of the still relatively small minority of people with this viral variant progressed to clinically defined AIDS within 3 years of infection. The variant also seems to be becoming more common in Cuba and may partly explain what appears to be an increase in the proportion of people who progress rapidly to AIDS. However, it is not a drug-resistant strain and antiretroviral therapy (ART) works just as well against it as it does against any other strain of HIV.

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Elite Controllers Have Higher Hospitalization Rate, HIV May Hide in B-Cells

Elite controllers -- people who naturally maintain viral suppressed without antiretroviral treatment -- had higher rates of hospitalization than people with HIV on antiretroviral therapy, most commonly for cardiovascular conditions, researchers reported in the December 15 Journal of Infectious Diseases. A related study showed that B cell follicles may act as a reservoir for an HIV-like virus in elite controller monkeys.

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HIV Has Become More Virulent Over Time, Not Less, European Study Finds

The largest cohort study ever to look at CD4 count and viral loads in HIV positive people around the time of diagnosis has found evidence that HIV -- at least in Europe -- has become more virulent over time. The average time taken to reach a CD4 count below 350 cells/mm3 has halved over the last 25 years, researchers calculate. This conflicts with recently reported findings from Africa suggesting HIV has gotten weaker, suggesting that local conditions may drive viral evolution in opposite directions.

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Smoking Doubles Risk of Death for People with HIV Taking Antiretroviral Therapy

Smoking doubles the mortality risk for people with HIV taking antiretroviral therapy, a study published recently in AIDS shows. Smokers had an increased risk of death from cardiovascular disease (CVD) and non-AIDS-related cancers, and the life expectancy of a 35-year-old man with HIV was reduced by almost 8 years due to smoking.

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Delaying Treatment More than 12 Months after HIV Infection Reduces CD4 Cell Recovery

People with HIV who start antiretroviral therapy (ART) more than a year after seroconversion have a lower likelihood of regaining normal CD4 T-cell counts, researchers reported in the November 24 online edition of JAMA Internal Medicine. "If full restoration of immunologic and clinical health is our goal, then the present study tells us that the best chance we have is to start antiretroviral therapy within 12 months of infection," according to an accompanying editorial.

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