Human Immunodeficiency Virus Type 1 Subtypes Differ in Disease Progression

At least 10 different genetic human immunodeficiency virus type 1 (HIV-1) subtypes (A—J) are responsible for the AIDS pandemic. Much of the understanding of HIV-1 disease progression derives from studies in the developed world where HIV infection is almost exclusively subtype B. This has led many to question whether the properties and consequences of HIV-1 infection can be generalized across subtypes that afflict the majority of infected persons in the developing world. From 1985 to 1997, a prospective study of registered female sex workers in Senegal tracked the introduction and spread of HIV-1 subtypes A, C, D, and G. In clinical follow-up, the AIDS-free survival curves differed by HIV-1 subtype. Women infected with a non-A subtype were 8 times more likely to develop AIDS than were those infected with subtype A (hazard ratio = 8.23; P = .009), the predominant subtype in the study. These data suggest that HIV-1 subtypes may differ in rates of progression to AIDS.