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Effects of CCR5-32 and CCR2-64I alleles on HIV-1 disease progression: the protection varies with duration of infection

Mulherin, Stephanie Aa,b; O'Brien, Thomas Ra; Ioannidis, John PAa,c; Goedert, James Ja; Buchbinder, Susan Pd; Coutinho, Roel Ae; Jamieson, Beth Df; Meyer, Laurenceg; Michael, Nelson Lh; Pantaleo, Giuseppei; Rizzardi, G Paoloi; Schuitemaker, Hannekej; Sheppard, Haynes Wk; Theodorou, Ioannis Dl; Vlahov, Davidm; Rosenberg, Philip Sa; ID="; for the International Meta-Analysis of HIV Host Genetics" itype="norm">for the International Meta-Analysis of HIV Host Genetics

Epidemiology & Social

Objective: To examine temporal variation in the effects of CCR5-Δ32 and CCR2-64I chemokine receptor gene polymorphisms on HIV-1 disease progression.

Design: Pooled analysis of individual patient data from 10 cohorts of HIV-1 seroconverters from the United States, Europe, and Australia.

Methods: We studied HIV-1 seroconverters of European (n = 1635) or African (n = 215) ancestry who had been genotyped for CCR5-Δ32 and CCR2-64I. We used Cox proportional hazards models with time-varying coefficients to determine whether the genetic protection against AIDS (1987 case definition) and death varied with time since seroconversion.

Results: Protection against AIDS conferred by CCR5-Δ32 held constant at a 31% (RH 0.69, 95% CI 0.54, 0.88) reduction in risk over the course of HIV-1 infection, whereas protection against death held constant at a 39% reduction in risk (RH 0.61, 95% CI 0.45, 0.88). When the period from AIDS to death was isolated, the survival benefit of CCR5-Δ32 diminished 2 years after AIDS. Protection against AIDS conferred by CCR2-64I was greatest early in the disease course. Compared with individuals without CCR5-Δ32 or CCR2-64I, individuals with one or two copies of CCR2-64I had a 58% lower risk of AIDS during the first 4 years after seroconversion (RH 0.42, 95% CI 0.23, 0.76), a 19% lower risk during the subsequent 4 years (RH 0.81, 95% CI 0.59, 1.12), and no significant protection thereafter.

Conclusion: The protection against AIDS provided by CCR5-Δ32 is continuous during the course of infection. In contrast, the protection provided by CCR2-64I is greatest early in the course of infection.

From the aDivision of Cancer Epidemiology and Genetics, NCI, NIH, DHHS, Rockville, MD 20852, USA; bDepartment of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, NC 27599, USA; cDepartment of Hygiene and Epidemiology, University of Ioannina School of Medicine and Ioannina Biomedical Research Institute, Ioannina 45110, Greece; dHIV Research Section, San Francisco Department of Public Health, San Francisco, CA 94102-6033, USA; eMunicipal Health Service Amsterdam, Department of Public Health and Environment, Amsterdam, the Netherlands; fDepartment of Medicine, Division of Hematology/Oncology, University of California at Los Angeles School of Medicine, Los Angeles, CA 90095-1745, USA; gService d'Epidemiologie – INSERM U292, Hopital de Bicetre, 94276 Le Kremlin-Bicetre Cedex, France; hDivision of Retrovirology, Walter Reed Army Institute of Research, Rockville, MD 20850, USA; iLaboratory of AIDS Immunopathogenesis, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; jDepartment of Clinical Viro-Immunology, Sanquin Research at CLB and Landsteiner Laboratory, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; kViral and Rickettsial Disease Laboratory, California Department of Health Services, Berkeley, CA 94704, USA; lLaboratoire Central d'Immunologic Cellulaire et Tissulaire, Hopital Pitie Salpetriere et CNRS UMR 7627, 75013 Paris, France; mCenter for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029.

Correspondence and requests for reprints to: Philip S. Rosenberg, Ph.D., Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd, Room 7006, Rockville MD 20852. Email: tel: 301-435-3996; fax: 301-402-0081.

Received: 10 May 2002; revised: 20 September 2002; accepted: 8 October 2002.

© 2003 Lippincott Williams & Wilkins, Inc.