期刊
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
卷 111, 期 50, 页码 E5393-E5400出版社
NATL ACAD SCIENCES
DOI: 10.1073/pnas.1413339111
关键词
HLA; HIV; adaptation; antiretroviral therapy; virulence
资金
- National Institutes of Health [R01AI46995]
- Wellcome Trust
- Medical Research Council UK
- New Investigator Award (Canadian Institutes of Health)
- Michael Smith Foundation for Health Research
- MRC [MR/L006588/1, G0501777] Funding Source: UKRI
- Medical Research Council [MR/L006588/1, 1240479, G0501777] Funding Source: researchfish
- National Institute for Health Research [CL-2011-13-005] Funding Source: researchfish
It is widely believed that epidemics in new hosts diminish in virulence over time, with natural selection favoring pathogens that cause minimal disease. However, a tradeoff frequently exists between high virulence shortening host survival on the one hand but allowing faster transmission on the other. This is the case in HIV infection, where high viral loads increase transmission risk per coital act but reduce host longevity. We here investigate the impact on HIV virulence of HIV adaptation to HLA molecules that protect against disease progression, such as HLA-B*57 and HLA-B*58:01. We analyzed cohorts in Botswana and South Africa, two countries severely affected by the HIV epidemic. In Botswana, where the epidemic started earlier and adult seroprevalence has been higher, HIV adaptation to HLA including HLA-B*57/58:01 is greater compared with South Africa (P = 7 x 10(-82)), the protective effect of HLA-B*57/58: 01 is absent (P = 0.0002), and population viral replicative capacity is lower (P = 0.03). These data suggest that viral evolution is occurring relatively rapidly, and that adaptation of HIV to the most protective HLA alleles may contribute to a lowering of viral replication capacity at the population level, and a consequent reduction in HIV virulence over time. The potential role in this process played by increasing antiretroviral therapy (ART) access is also explored. Models developed here suggest distinct benefits of ART, in addition to reducing HIV disease and transmission, in driving declines in HIV virulence over the course of the epidemic, thereby accelerating the effects of HLA-mediated viral adaptation.
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