TY - JOUR T1 - The effects of HIV-1 subtype and ethnicity on the rate of CD4 cell count decline in patients naive to antiretroviral therapy: a Canadian−European collaborative retrospective cohort study JF - CMAJ Open SP - E318 LP - E329 DO - 10.9778/cmajo.20140017 VL - 2 IS - 4 AU - Marina B. Klein AU - Jim Young AU - David Dunn AU - Bruno Ledergerber AU - Caroline Sabin AU - Alessandro Cozzi-Lepri AU - Francois Dabis AU - Richard Harrigan AU - Darrell H. Tan AU - Sharon Walmsley AU - John Gill AU - Curtis Cooper AU - Alexandra U. Scherrer AU - Amanda Mocroft AU - Robert S. Hogg AU - Fiona Smaill AU - for the Canadian−European Clade Collaboration Y1 - 2014/10/01 UR - http://www.cmajopen.ca/content/2/4/E318.abstract N2 - Background Ethnic differences have the potential to confound associations between HIV-1 subtype and immunologic progression. We compared declines in CD4 cell counts during untreated infection for the most prevalent HIV-1 subtypes, focusing on distinguishing between the effects of viral subtype and ethnicity. Methods We combined data from 4 European and 6 Canadian cohorts, selecting adults in the stable chronic phase of untreated HIV infection. We estimated the change in square root CD4 cell count over time for subtypes and ethnicities using mixed models, adjusting for covariates selected for their potential effect on initial CD4 cell count or its decline. Results Data from 9772 patients were analyzed, contributing 79 175 measurements of CD4 cell count and 24 157 person-years of follow-up. Overall, there were no appreciable differences in CD4 cell count decline for viral subtypes A, CRF01_AE, CRF02_AG, C and G compared with viral subtype B; whereas the decline in CD4 cell count in patients of African ancestry was considerably slower than in patients of other ethnicity. When ethnic groups were studied separately, there was evidence for slower declines in CD4 cell count in viral subtypes C, and possibly A and G, compared with viral subtype B in patients of African ancestry but not among patients of other ethnicities, suggesting an interaction between subtype and ethnicity. Interpretation Ethnicity is a major determinant of CD4 cell count decline; viral subtype differences may have existed but were small compared with the effect of ethnicity and were most apparent in patients of African ancestry. In developing countries, slower CD4 cell count declines among individuals of African descent may translate to a longer asymptomatic phase and increase the opportunity for HIV transmission. ER -