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Wall KM, Rida W, Haddad LB, Kamali A, Karita E, Lakhi S, Kilembe W, Allen S, Inambao M, Yang AH, Latka MH, Anzala O, Sanders EJ, Bekker LG, Edward VA, Price MA. Pregnancy and HIV Disease Progression in an Early Infection Cohort from Five African Countries. Epidemiology 2017; 28:224-232. [PMID: 27893488 PMCID: PMC5287431 DOI: 10.1097/ede.0000000000000590] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 11/14/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Understanding associations between pregnancy and HIV disease progression is critical to provide appropriate counseling and care to HIV-positive women. METHODS From 2006 to 2011, women less than age 40 with incident HIV infection were enrolled in an early HIV infection cohort in Kenya, Rwanda, South Africa, Uganda, and Zambia. Time-dependent Cox models evaluated associations between pregnancy and HIV disease progression. Clinical progression was defined as a single CD4 measurement <200 cells/μl, percent CD4 <14%, or category C event, with censoring at antiretroviral (ART) initiation for reasons other than prevention of mother-to-child transmission (PMTCT). Immunologic progression was defined as two consecutive CD4s ≤350 cells/μl or a single CD4 ≤350 cells/μl followed by non-PMTCT ART initiation. Generalized estimating equations assessed changes in CD4 before and after pregnancy. RESULTS Among 222 women, 63 experienced clinical progression during 783.5 person-years at risk (8.0/100). Among 205 women, 87 experienced immunologic progression during 680.1 person-years at risk (12.8/100). The association between pregnancy and clinical progression was adjusted hazard ratio [aHR] = 0.7; 95% confidence interval (CI): 0.2, 1.8. The association between pregnancy and immunologic progression was aHR = 1.7; 95% CI: 0.9, 3.3. Models controlled for age; human leukocyte antigen alleles A*03:01, B*45, B*57; CD4 set point; and HIV-1 subtype. CD4 measurements before versus after pregnancies were not different. CONCLUSIONS In this cohort, pregnancy was not associated with increased clinical or immunologic HIV progression. Similarly, we did not observe meaningful deleterious associations of pregnancy with CD4s. Our findings suggest that HIV-positive women may become pregnant without harmful health effects occurring during the pregnancy. Evaluation of longer-term impact of pregnancy on progression is warranted.
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Affiliation(s)
- Kristin M. Wall
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Wasima Rida
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Lisa B. Haddad
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Anatoli Kamali
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Etienne Karita
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Shabir Lakhi
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - William Kilembe
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Susan Allen
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Mubiana Inambao
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Annie H. Yang
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Mary H. Latka
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Omu Anzala
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Eduard J. Sanders
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Linda-Gail Bekker
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Vinodh A. Edward
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
| | - Matt A. Price
- From the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA; Biostatistics Consultant, Arlington, VA; Department of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, GA; Medical Research Council/Uganda Virus Research Unit, Research Unit on AIDS, Entebbe, Uganda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Kigali, Rwanda; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Lusaka, Zambia; Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health and the Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Ndola, Zambia; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; The Aurum Institute, Johannesburg and Rustenburg, South Africa; Kenya AIDS Vaccine Initiative Institute of Clinical Research, University of Nairobi, Nairobi, Kenya; Centre for Geographic Medicine-Coast/Kenya Medical Research Institute, Kilifi, Kenya; University of Oxford, Oxford, United Kingdom; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Republic of South Africa; School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International AIDS Vaccine Initiative, New York, NY; and Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA
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