HIV status of female sex partners of men reactive to HIV-1, HIV-2 or both viruses in Abidjan, Côte d'Ivoire.

OBJECTIVES: To compare rates of serologic concordance in the female sex partners of men with HIV-1 and HIV-2 infections, and to determine the serologic status of sex partners of men who reacted serologically to both viruses. DESIGN: Cross-sectional study. SETTING: Infectious diseases service in a University Hospital in Abidjan, Côte d'Ivoire (West Africa). PARTICIPANTS: Hospitalized men reactive on synthetic peptide-based tests to HIV-1, HIV-2 or both viruses (dually reactive), and their spouses visiting them in hospital. OUTCOME MEASURES: Serologic status of female spouses of seropositive men. RESULTS: The serologic status of 540 spouses of 490 HIV-1- and/or HIV-2-positive, hospitalized men was studied. Similar proportions of spouses of HIV-1-infected men (49%) and HIV-2-infected men (44%) were concordantly seropositive. The overall prevalence of infection in spouses of dually reactive men (72%) was significantly higher than in spouses of other men; 44% of these spouses were infected with HIV-1, 8% with HIV-2, and 20% were themselves dually reactive. Considering only the seropositive female spouses of men monotypically reactive to HIV-1 or HIV-2, and the male spouses of women monotypically infected, rates of serologic discordance were significantly greater in men (24%) than women (7%). CONCLUSIONS: Men were likely to have been infected earlier than women because of their HIV-associated illness; also, men more frequently had serologic profiles indicative of infection outside of the union. Rates of serologic concordance in spouses of men with advanced HIV-1 or HIV-2 infection were similar (44-49%). Dually reactive hospitalized men frequently (72%) had seropositive sex partners, most of whom were HIV-1-positive. Dual reactivity was also frequent in these spouses, suggesting transmission of both HIV-1 and HIV-2, or of a cross-reactive strain, and a minority of partners were infected with HIV-2 alone. Prospective studies of discordant couples using quantitative molecular diagnostic techniques are required for better understanding of dual reactivity and transmission of HIV-1 and HIV-2.

Clinical spectrum of human immunodeficiency virus disease in children in a west African city. Project RETRO-CI.

OBJECTIVES: To determine the prevalence of HIV infection in children and to compare diagnostic syndromes and outcomes in HIV-positive and HIV-negative children. METHODS: Consecutive children hospitalized in Abidjan's three university hospitals were examined, tested for HIV infection and followed to discharge. Admission or discharge diagnoses and outcome (survived or died) were compared in HIV-positive and HIV-negative children. RESULTS: The prevalence of HIV infection in the 4480 children hospitalized for the first time was 8.2%; the highest age-specific rate (11.2%) was in children ages 15 to 23 months. Six clinical syndromes accounted for more than 80% of admissions in HIV-positive and -negative children (all ages combined): respiratory infection; malnutrition; malaria; anemia; diarrhea; and meningitis. The dominant syndromic diagnoses in HIV-positive children were respiratory infection (26.1%) and malnutrition (25.8%); in HIV-negative children they were malaria (30.4%) and respiratory infection (19.1%). The overall mortality rate in HIV-positive children was 20.8%, compared with 8.7% in HIV-negative children (relative risk, 2.4; 95% confidence interval, 1.9 to 3.1); the highest death rate (28.1%) was in children younger than 15 months. CONCLUSIONS: Clinical syndromes associated with HIV infection in African children are difficult to recognize without access to HIV serology. Respiratory infection and malnutrition were the dominant clinical syndromes in HIV-positive children in Abidjan. Greater overlap exists between the clinical presentations of HIV-associated disease and other common health problems in African children than in adults.

Retrospective study of maternal HIV-1 and HIV-2 infections and child survival in Abidjan, Côte d'Ivoire.

OBJECTIVES: To compare the effects of maternal HIV-1 and HIV-2 infections on outcome of pregnancy, infant mortality, and child survival, and to measure serological concordance between mothers and children. DESIGN: Retrospective cohort study with cross sectional study of concordance for HIV antibodies. SETTING: Hospital, tuberculosis clinic, and maternal and child health centre in Abidjan, Côte d'Ivoire, west Africa. SUBJECTS: 986 women who had had a total of 2758 pregnancies since 1980. The last born children of 194 of these women. MAIN OUTCOME MEASURES: Pregnancy outcomes; mortality for all children born since 1980; and outcome for last born children. Serological concordance between mothers and last born children. RESULTS: Women with HIV-1 and HIV-2 infections had higher rates of spontaneous abortion and stillbirth than uninfected women (86/769 in HIV-1 positive women, 48/421 in HIV-2 positive, 31/234 in dually reactive, and 96/1131 in uninfected). Compared with children born to uninfected mothers (mortality 10.3%), greater proportions of children of HIV-1 positive (20.6%) and dually reactive (20.3%) mothers had died; mortality in children of HIV-2 infected women (13.1%) was not significantly increased. Infant mortalities for the last born children of HIV-1 positive, dually reactive, HIV-2 positive, and seronegative women were, respectively, 133, 82, 32, and 40 per 1000 live births. Nine of 77 last born children of HIV-1 positive mothers were concordantly seropositive compared with none of 21 children of HIV-2 infected mothers. CONCLUSIONS: Maternal HIV-2 infection has less influence on child survival than infection with HIV-1, probably because of a lower vertical transmission rate.