Clinical disease associated with HIV-1 subtype B‚ _and E infection among 2104 patients in Thailand

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Abstract
Two HIV-1 envelope subtypes have accounted for virtually all infections in Thailand: subtype B‚ (Thai B), found mainly in injection drug users (IDU), and subtype E, found in over 90% of sexually infected persons and an increasing proportion of IDU in recent years. It remains unclear whether there are differences in pathogenesis associated with these HIV-1 subtypes. From November 1993 to June 1996, demographic, risk, clinical, and laboratory data were collected by enhanced surveillance from HIV-infected inpatients (≥_14 years) at an infectious disease hospital near Bangkok. HIV-1 subtype was determined by V3-loop peptide enzyme immunoassay (EIA). Because of confounding, multivariate analyses were stratified by risk category and controlled for sex and age. The infecting HIV-1 subtype was determined for 2104 (94.9%) of 2217 HIV-infected patients with complete data: 284 (13.5%) were subtype B‚, 1820 (86.5%) were E. Specimens from 113 (5.1%) patients were non-reactive or dually reactive on peptide EIA and were excluded. Among IDU, 199 (67.2%) had subtype B‚, and 97 (32.7%) had E. IDU accounted for 70.1% (199/284) of patients with subtype B‚ and 5.3% (97/1820) of those with E. Patients infected with HIV-1 subtypes B‚ or E had similar spectrums of opportunistic infections (OI), levels of immunosuppression, and in-hospital mortality rates. Of patients who did not inject drugs, more patients infected with subtype E had extrapulmonary cryptococcosis than those with subtype B‚ (adjusted odds ratio, 2.6; 95% confidence interval, 1.28-5.37). HIV-1 subtypes B‚ and E seem to be associated with similar degrees of immunosuppression and, with one exception, with similar OI patterns. These data do not suggest an association between HIV-1 subtype and differences in pathogenicity.