Have the explosive HIV epidemics in sub-Saharan Africa been driven by higher community viral load?

Laith Aburaddad, Ruanne V. Barnabas, Holly Janes, Helen A. Weiss, James G. Kublin, Ira M. Longini, Judith N. Wasserheit

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: The HIV epidemic has carved contrasting trajectories around the world with sub-Saharan Africa (SSA) being most affected. We hypothesized that mean HIV-1 plasma RNA viral loads are higher in SSA than other areas, and that these elevated levels may contribute to the scale of epidemics in this region. Design and methods: To evaluate this hypothesis, we constructed a database of means of 71 668 viral load measurements from 44 cohorts in seven regions of the world. We used linear regression statistical models to estimate differences in viral load between regions. We also constructed and analyzed a mathematical model to describe the impact of the regional viral load differences on HIV epidemic trajectory. Results: We found substantial regional viral load heterogeneity. The mean viral load in SSA was 0.58 log10 copies/ml higher than in North America (95% confidence interval 0.45-0.71); this represents about a four-fold increase. The highest mean viral loads were found in Southern and East Africa, whereas in Asia, Europe, North America, and South America, mean viral loads were comparable. Mathematical modeling indicated that conservatively 14% of HIV infections in a representative population in Kenya could be attributed to the enhanced infectiousness of patients with heightened viral load. Conclusion: We conclude that community viral load appears to be higher in SSA than in other regions and this may be a central driver of the massive HIV epidemics in this region. The elevated viral loads in SSA may reflect, among other factors, the high burden of co-infections or the preponderance of HIV-1 subtype C infection.

Original languageEnglish
Pages (from-to)981-989
Number of pages9
JournalAIDS
Volume27
Issue number6
DOIs
Publication statusPublished - 27 Mar 2013
Externally publishedYes

Fingerprint

Africa South of the Sahara
Viral Load
HIV
North America
HIV-1
Southern Africa
Eastern Africa
South America
Kenya
Statistical Models
Coinfection
HIV Infections
Linear Models
Theoretical Models
Databases
RNA
Confidence Intervals

Keywords

  • Co-infection
  • Epidemic
  • HIV
  • Mathematical model
  • Sub-Saharan Africa
  • Viral load

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Aburaddad, L., Barnabas, R. V., Janes, H., Weiss, H. A., Kublin, J. G., Longini, I. M., & Wasserheit, J. N. (2013). Have the explosive HIV epidemics in sub-Saharan Africa been driven by higher community viral load? AIDS, 27(6), 981-989. https://doi.org/10.1097/QAD.0b013e32835cb927

Have the explosive HIV epidemics in sub-Saharan Africa been driven by higher community viral load? / Aburaddad, Laith; Barnabas, Ruanne V.; Janes, Holly; Weiss, Helen A.; Kublin, James G.; Longini, Ira M.; Wasserheit, Judith N.

In: AIDS, Vol. 27, No. 6, 27.03.2013, p. 981-989.

Research output: Contribution to journalArticle

Aburaddad, L, Barnabas, RV, Janes, H, Weiss, HA, Kublin, JG, Longini, IM & Wasserheit, JN 2013, 'Have the explosive HIV epidemics in sub-Saharan Africa been driven by higher community viral load?', AIDS, vol. 27, no. 6, pp. 981-989. https://doi.org/10.1097/QAD.0b013e32835cb927
Aburaddad, Laith ; Barnabas, Ruanne V. ; Janes, Holly ; Weiss, Helen A. ; Kublin, James G. ; Longini, Ira M. ; Wasserheit, Judith N. / Have the explosive HIV epidemics in sub-Saharan Africa been driven by higher community viral load?. In: AIDS. 2013 ; Vol. 27, No. 6. pp. 981-989.
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