A prospective study of vertical transmission of HIV-2 in Bissau, Guinea-Bissau.

OBJECTIVES: To determine the vertical transmission rate of HIV-2 and clinical findings associated with vertically transmitted HIV-2 infection. DESIGN: A prospective study of HIV-2 transmission in children of HIV-2-seropositive mothers, and a comparison of clinical findings between children of seropositive and seronegative mothers. SETTING: Recruitment of women delivering at the national hospital in Bissau, Guinea-Bissau. Follow-up by home visits. SUBJECTS AND METHODS: Eighty-six newborns of 82 HIV-2-seropositive mothers and a control group of 102 newborns of HIV-seronegative mothers were followed-up clinically and by HIV serology until the children reached the age of 20 months. RESULTS: Of the 86 children of seropositive mothers, 51 had a complete follow-up, 22 died and 13 were lost due to change of residence. Of the 102 children of seronegative mothers, 63 had a complete follow-up, 13 died and 26 were lost due to change of residence. None of 51 children of seropositive mothers had serological evidence of HIV-2 infection at the end of the follow-up period. There was no significant difference in the frequency of clinical symptoms between the children in the study group and the children in the control group. The mortality during the first year of life was not significantly different between the children of seropositive and seronegative mothers (13 out of 80 and 11 out of 94, respectively, P > 0.05, excluding children lost to follow-up). Only three of the dead children of seropositive mothers and one of the dead children of seronegative mothers had any symptoms that might be related to HIV-2 infection (diarrhoea > 1 month). CONCLUSION: Vertical transmission of HIV-2 appears to be rare.

PIP: Between May 1987 and December 1988 in Guinea-Bissau, health workers followed 86 HIV-2 seropositive mothers and their infants delivered at the National Hospital Simao-Mendes in Bissau for 20 months to learn the HIV-2 vertical transmission rate and to compare their clinical findings with those of 102 infants of HIV-2 seronegative women. The ELISA and Western Blot analysis used antigen-purified virions of the SBL-6669 strain of HIV-2 grown on U937:2 cells. During the enrollment period, hospital workers tested 3246 women; tests confirmed that 211 (6.5%) and 3 (0.1%) were HIV-2 seropositive, respectively. 1 HIV-2 seronegative mother seroconverted during the study, but none of the infants of HIV-2 seronegative mothers seroconverted. Infant mortality of cases did not differ significantly from that of controls (16.2% vs. 11.7%). After 1 year of age, however, children of HIV-2 seropositive mothers were significantly more likely to die than the controls (15% vs. 3%; p .05). When the researchers added the children lost to follow up, there no longer was a significant difference in mortality after 1 year (23.9% vs. 24.1%). Just 3 of the deceased infants of the HIV-2 seropositive mothers and 1 of the deceased infants of seronegative mothers suffered from symptoms from symptoms that may have been related to HIV-2 infection. 1 of these deceased infants was HIV-2 seropositive at 12 months. These symptoms included prolonged fever, vomiting, diarrhea, and respiratory symptoms. Children in the study group did not experience more frequent clinical symptoms of HIV-2 infection than did the controls during the 3rd and 4th home visits. At the last visit (i.e., 4th visit; when the children were older than 17 months), none of the children of the HIV-2 seropositive mothers tested positive for HIV- 2. Vertical transmission of HIV-2 infection may be rare.

Enzyme immunoassays for the demonstration of antibodies to HIV-2SBL-6669 and HTLV-IV (SIVmac).

Enzyme-linked immunosorbent assays (ELISA) were developed for the demonstration of antibodies to HIV-2 using disrupted virions of the SBL-6669 isolate of HIV-2 and the so-called human T-lymphotropic virus type IV (HTLV-IV), recently found to be identical with the simian immunodeficiency virus (SIVmac), as antigens. Three hundred sera from West African subjects, attending an outward clinic in Bissau for examination of suspected tuberculosis, were tested by these two assays as well as by a commercially available anti-HIV-2 ELISA (ELAVIA II). Fifty of these sera were positive in all three ELISAs as well as in Western blot tests against HTLV-IV. Thirty-eight of these positive sera were also tested by an anti-HIV-2 Western blot kit (LAV-Blot II) with positive results. The ELISAs based on SBL-6669 and HTLV-IV antigens had a specificity of 99.6% (one false positive among 250 negative sera) whereas the specificity of ELAVIA II was 94.6% using the recommended cut-off value and 98.4% using a higher cut-off value. Another 58 sera from West African patients, clinically suspected of having AIDS or HIV-related disease, were tested for HIV-2/HTLV-IV antibodies by Western blot and by ELISA against SBL-6669 and HTLV-IV antigens; all of the 30 sera which were positive by Western blot were found to be positive in both ELISAs.(ABSTRACT TRUNCATED AT 250 WORDS)

HIV-2 infection in hospitalized patients in Bissau, Guinea-Bissau.

During 11 months in 1989-1990, 1009 consecutive hospitalized adult patients admitted to the medical wards of the National Hospital in Bissau were interviewed, examined clinically, and tested for antibodies to HIV-1 and HIV-2. The prevalence of HIV-2 infection was 20.4% (206 out of 1009) and of HIV-2-associated AIDS 4.4% (44 out of 1009). HIV-2 infection was more frequent in women (25%, 110 out of 440) than in men (16.9%, 96 out of 569). HIV-1 infection was diagnosed in one patient only, and one patient (with AIDS) had reactivity to both HIV-1 and HIV-2. Among HIV-2-seropositive patients, AIDS was demonstrated in 21.3% and AIDS-related symptoms (not fulfilling the AIDS criteria) in 19.4%. The frequency of AIDS-associated symptoms was significantly higher in HIV-2-seropositive patients than in seronegative patients. The clinical profile of the HIV-2-associated AIDS cases was very similar to that described in HIV-1-associated AIDS cases in Africa. Seven out of 51 patients fulfilling the clinical criteria for AIDS were HIV-seronegative. The World Health Organization (WHO) clinical case definition for AIDS in Africa had a specificity of 99% and a positive predictive value of 86%. Tuberculosis was more common in HIV-2-seropositive patients (6.3%) than in HIV-2-seronegative patients (2.2%). A history of blood transfusion was a significant risk factor for HIV-2 infection. HIV-2 infection and AIDS are public health problems in Guinea-Bissau.

Site-directed enzyme-linked immunosorbent assay with a synthetic simian immunodeficiency virus SIVmac peptide identifying antibodies against the HIV-2 transmembrane glycoprotein.

A 23-amino-acid-long peptide (AIEKYLEDQAQLNAWGCAFRQVC) representing the transmembranous protein gp32 in SIVmac was used in site-directed enzyme-linked immunosorbent assay (ELISA) for detection of HIV-2-specific antibodies in 567 sera from Bissau, Guinea Bissau. Ninety out of the 567 sera were identified to contain HIV-2 antibodies by whole antigen ELISA and Western blot assays. The peptide ELISA correctly identified 89 out of these 90 seropositives (sensitivity 98.9%). Three sera falsely interpreted to be positive were encountered (specificity 99.4%). The HIV-2 peptide was also used for testing of 93 HIV-1-positive Swedish sera. None of these sera reacted. Site-directed serology employing synthetic peptides should be considered for application as a screening assay.

PIP: HIV-1 is predominant in Central and East Africa, while HIV-2 is predominant in West Africa. The HIV-2 virus, originally described as human T-lymphotropic virus type IV, is identical to the simian immunodeficiency virus SIV-mac. Whole-antigen enzyme-linked immunosorbent assay (ELISA) can detect heterotypic antigens in 80% of sera, but separate tests are required for detecting HIV-1 and HIV-2. Site-directed ELISA using amino acids 586-620 of the synthetic transmembranous protein gp41 as antigen has been used for type-specific antibody determination in HIV-1. The homologous site on the 23-amino-acid-long peptide AIEKYLEDQAQLNAWGCAFRQVC representing the transmembranous protein gp32 in the simian immunodeficiency virus SIV-mac is WGCAFR, which can be used in site-directed serology of HIV-2. This approach was tested on sera from 567 Africans in Guinea-Bissau and 49 suspected AIDS patients. None of these sera had HIV-1 antibodies. 93 HIV-1-positive sera from Sweden were used as controls. The HIV-2 peptide ELISA correctly identified 89 of the 90 HIV-2 seropositives out of the sample of 567. The peptide ELISA also correctly identified all of the 93 HIV-1-positive sera as HIV-2-negative. Use of HIV-2-specific ELISA in combination with an HIV-1-specific ELISA can efficiently screen blood for both types of HIV.

Trends and interaction of HIV-1 and HIV-2 in Guinea-Bissau, west Africa: no protection of HIV-2 against HIV-1 infection.

OBJECTIVES: To study trends in the prevalence and incidence of HIV-1 and HIV-2 infections in Guinea-Bissau over the last 7 years, and to evaluate the protective effect of HIV-2 against HIV-1 infection. DESIGN: Prospective follow-up of a cohort of police officers in Guinea-Bissau, and sentinel surveillance of pregnant women in Bissau. METHODS: Participants in the police cohort were tested regularly for antibodies to HIV and Treponema pallidum, and information about sexual risk behaviour and a history of sexually transmitted diseases was obtained. Simultaneously, pregnant women at the maternity wards at the National Hospital in Bissau were screened annually for HIV antibodies. To evaluate changes in prevalence and incidence of HIV in the police cohort, the study period was divided into three time strata with 2-3 years in each stratum. For the evaluation of a protective effect of HIV-2 on subsequent HIV-1 infection, two multivariate Poisson regression models were constructed, adjusting for different selected confounding variables. RESULTS: Between 1990 and 1997, 2637 police officers were included in the cohort study, 90.7% of whom were male. The overall prevalence of HIV-1 was 0.9%, of HIV-2 it was 9.7% and of HIV-1 and HIV-2 dual reactivity it was 0.5%. For pregnant women the prevalence rates were 0.9, 5.5 and 0.2% for HIV-1, HIV-2 and dual reactivity respectively. The prevalence of HIV-1 increased significantly whereas the prevalence of HIV-2 declined significantly during the study period, among both police officers and pregnant women. The total incidence of HIV-1 and HIV-2 was 0.74 and 0.83 per 100 person-years respectively in the police cohort. The incidence of HIV-1 increased slightly from 0.62 to 0.78 per 100 person-years (not significant), whereas the incidence of HIV-2 declined significantly from 0.90 to 0.35 per 100 person-years over the study period. Seven police officers seroconverted from HIV-2 to dual reactivity (1.22 per 100 person-years). The adjusted incidence ratio of acquiring HIV-1 infection among HIV-2-positive subjects compared with HIV-negative subjects was 1.65 [95% confidence interval (CI), 0.73-3.74] and 1.98 (95% CI, 0.80-4.87), depending on the confounding variables included. CONCLUSIONS: Our study shows an increasing prevalence of HIV-1 and a decreasing prevalence of HIV-2 in Guinea-Bissau. The incidence of HIV-2 declined significantly whereas the incidence of HIV-1 was relatively stable over the study period. No protective effect of HIV-2 against subsequent HIV-1 infection was observed, instead HIV-2-positive subjects had a tendency towards higher risk of acquiring HIV-1 infection compared with seronegative subjects.

Declining HIV-2 prevalence and incidence among men in a community study from Guinea-Bissau.

OBJECTIVE: To assess the present level of HIV-2 infection in an adult population in Bissau and to evaluate sex and age-specific changes in HIV-2 prevalence and incidence between 1987 and 1996. DESIGN AND METHODS: Sex and age-specific changes in HIV-2 prevalence were evaluated comparing a survey from 1987 in a sample of 100 houses with a survey performed in 1996 in an independent sample of 212 houses from the same study area. HIV-2 incidence rates were examined in an adult population (age > or = 15 years) from 100 randomly selected houses followed with four consecutive HIV serosurveys from 1987 to 1996. RESULTS: The HIV-2 prevalence in 1996 was 6.8% (men, 4.7%; women, 8.4%). Compared with the 1987 survey there was a significant decrease in prevalence among men [age-adjusted relative risk (RR), 0.50; 95% confidence interval (CI), 0.31-0.83], whereas it remained unchanged in women (RR, 1.00; 95% CI, 0.67-1.48). The male-to-female RR decreased from 0.99 (95% CI, 0.61-1.61) in 1987 to 0.51 (95% CI, 0.34-0.76) in 1996. The overall annual incidence rate was 0.54 per 100 person-years of observation (PYO), being higher in women (0.72 per 100 PYO) than in men (0.31 per 100 PYO). With the observation time divided into an early and a late period, there was a decrease in incidence with time among men (0.66 to 0.00 per 100 PYO), but no major change among women (0.59 to 0.85 per 100 PYO). The two trends differed significantly (P = 0.03). We observed a higher annual incidence rate amongst older women aged > 44 years (1.77 per 100 PYO) than among younger women (0.55 per 100 PYO; P = 0.05). CONCLUSION: There are no signs of an epidemic spread of HIV-2 in Bissau even though the HIV-1 prevalence is increasing rapidly. A significant reduction in the male HIV-2 prevalence and incidence rates has resulted in a major shift in the pattern of spread of HIV-2, from being equally distributed to being predominantly a female infection. Currently, older women in particular seem to have a high risk of getting infected.

Replicative capacity of HIV-2, like HIV-1, correlates with severity of immunodeficiency.

We have obtained 15 HIV-2 isolates from the peripheral blood mononuclear cells (PBMCs) of 24 HIV-2-infected west African people. The frequency of virus isolation correlated with the severity of HIV-2 infection; only three isolates were obtained from 11 asymptomatic individuals, whereas virus was isolated from nearly all (12 of 13) individuals with symptoms. The HIV-2 isolates showed distinct replicative and cytopathic characteristics and, similarly to HIV-1 isolates, could be divided into two major groups: rapid/high and slow/low. Rapid/high isolates, i.e. isolates with the ability to replicate in tumour cell lines, were obtained from individuals with symptomatic HIV-2 infection and CD4+ lymphocyte counts less than 360/microliters blood; these isolates induced syncytia in PBMC cultures. HIV-2 isolates unable to replicate continuously in tumour cell lines (slow/low isolates) induced small syncytia, cell death, or no cytopathic effect at all. All HIV-2 isolates obtained from asymptomatic individuals showed a slow/low replication pattern.

HIV-2-associated AIDS and HIV-2 seroprevalence in Bissau, Guinea-Bissau.

During a 6-month period in 1987, we examined patients clinically suspected of the acquired immune deficiency syndrome (AIDS) at the national hospital in Bissau, the capital of Guinea-Bissau, and found 20 cases that fulfilled the criteria for AIDS. The two most prevalent major symptoms were weight loss and diarrhea, and the most common minor symptoms generalized lymphadenopathy and generalized dermatitis. Six of 20 patients died within a couple of months. Nineteen of 20 patients were tested for human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) antibodies and were shown to be HIV-2 seropositive. During the same time period, a seroprevalence study of HIV-2 and HIV-1 was carried out, including 2,122 patients or healthy persons in Bissau. Antibodies to HIV-2 were demonstrated by enzyme-linked immunosorbent assay and verified by Western blot analysis in 8.6% (46/535) of prenatal women, in 7.9% (9/114) of women attending a family-planning clinic, in 4.4% (19/427) of applicants for scholarships, in 17.6% (16/91) of blood donors tested during the first 2 months and 5.3% (10/189) of blood donors tested during the following months, in 5.7% (2/35) of police officers, in 36.7% (11/30) of female prostitutes, in 15.8% (97/614) of outpatients suspected of having tuberculosis, and in 55.2% (48/87) of patients clinically suspected of AIDS or AIDS-related disease. One of 2,001 subjects tested had antibodies specific for HIV-1. Another subject had an antibody pattern compatible with both HIV-1 and HIV-2 infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Improved detection of HIV-2 DNA in clinical samples using a nested primer-based polymerase chain reaction.

A two-step polymerase chain reaction (PCR), with four double (nested) primer pairs, used for the detection of HIV-2 in clinical samples is described. With these four nested primer pairs we could detect HIV-2 DNA in 17 of 17 virus isolates and in blood mononuclear cell samples from 31 of 37 (83.7%) seropositive individuals after ethidium bromide staining of the amplified DNA. The nested primer PCR was also compared with a single primer pair-based PCR followed by hybridization. The sensitivities of the two methods were almost equal, but the nested primer PCR offered obvious technical advantages.

Cross-neutralizing antibodies against HIV-1 (HTLV-IIIB and HTLV-IIIRF) and HIV-2 (SBL-6669 and a new isolate SBL-K135).

A total of 57 HIV-1 antibody-positive sera and 43 HIV-2 antibody-positive sera were all tested for neutralizing capacity against two HIV-1 isolates (HTLV-IIIB and HTLV-IIIRF) and two HIV-2 isolates (SBL-6669 and SBL-K135). SBL-K135 is a new HIV-2 isolate obtained from a patient with clinical AIDS from Guinea-Bissau. Among the HIV-1--positive sera, 84% neutralized any of the HIV-1 isolates, 67% neutralized both HIV-1 isolates, and 35% neutralized any of the HIV-2 isolates. Among the HIV-2--positive sera, 91% neutralized any of the HIV-2 isolates, 67% neutralized both HIV-2 isolates, and 37% neutralized any of the HIV-1 isolates. Thus, neutralizing antibodies in HIV-1-- and HIV-2--positive sera can be cross-reacting, type-specific, or strain-specific. The cross-neutralizing titers were lower than the neutralizing titers against the type-specific viral isolates. The presence of cross-neutralizing antibodies was related to the presence of neutralizing antibodies against both type-specific isolates.

Phenotypic characterization of mononuclear white cells using finger-prick blood and light microscopy.

A technique for the enumeration of T cell subsets in capillary blood for use in the field is described. Mononuclear white cells were separated from 0.4 ml capillary blood, kept covered by culture medium on a Multitest slide, and incubated with monoclonal antibodies to the CD2, CD4, CD8, and interleukin-2 receptor antigens. Secondary and tertiary alkaline phosphatase conjugates were used for labeling. The substrate gave a distinct blue surface staining to the positive lymphocytes. Comparison was made with a conventional immunofluorescent antibody technique (r = 0.95).

Three-year follow-up of patients with pulmonary tuberculosis in Guinea-Bissau, West Africa.

SETTING: Raoul Follereau Hospital, Bissau, Guinea-Bissau. OBJECTIVE: To study the long-term outcome of patients with bacteriologically verified tuberculosis (TB), with or without human immunodeficiency virus (HIV) co-infection. DESIGN: Sputum samples were collected from all patients referred to the hospital with clinical symptoms of pulmonary tuberculosis. Direct microscopy and culture was performed at the Health Laboratory. Patients with a culture positive for Mycobacterium tuberculosis were followed for 3 years, and underlying factors were analysed regarding the outcome of treatment. A group of sex and age-matched HIV-negative individuals was used as controls. RESULTS: Of 206 bacteriologically verified pulmonary TB patients, 168 were followed up. Antibodies to HIV-2 were found in 33 patients (19.6%); eight patients (4.8%) had antibodies to HIV-1 or showed dual reactivity. Of 149 patients discharged to follow ambulatory treatment, the survival rate of HIV-2-positive patients was 42.3% (11/26) and for HIV-negative patients it was 81.9% (95/116). The difference in survival between HIV-2-positive and HIV-negative patients was highly significant (P < 0.00001). HIV-negative TB patients had a significantly higher mortality than their controls (mortality ratio 3.75, 95% confidence interval 1.58-8.90). Most patients who survived, regardless of HIV status, also became free from symptoms compatible wtih pulmonary TB. CONCLUSION: Although the mortality rate among HIV-positive TB patients was very much higher than among HIV-negative patients, there are weighty arguments for active contact tracing and effective treatment of all TB patients.

Child survival in children born to HIV-2 infected women in Guinea-Bissau, West Africa.

We have retrospectively studied the effect of maternal HIV-2 infection and other risk factors on child survival at a family planning centre in Bissau, Guinea-Bissau. A total of 2109 women were included, and the seroprevalence of HIV-2 was 5.7%. Overall child mortality of all live births (n=5912) reported by the women (standardized for age of the mother) was slightly higher among children of HIV-2 seropositive mothers (16.3%) compared with children of HIV seronegative women (14.6%) (not significant). There was a significant association between low level of maternal education and increased child mortality, but no difference in the level of education was found between HIV-2 seropositive and seronegative women.

Intestinal parasites in HIV-2 associated AIDS cases with chronic diarrhoea in Guinea-Bissau.

Previous studies from African countries where HIV-1 infection is prevalent have shown that infections with Cryptosporidium parvum, Isospora belli and microsporidia are frequently associated with chronic diarrhoea in AIDS patients. The information about the occurrence of these parasites in HIV-2 associated AIDS cases with chronic diarrhoea is limited. We have performed a study of stool parasites in patients from Guinea-Bissau, the country with the highest prevalence of HIV-2 in the world. Stool specimens from 52 adult patients with chronic diarrhoea of which 37 were HIV-positive and fulfilling the clinical criteria of AIDS (five HIV-1, 28 HIV-2 and four dually infected with HIV-1 and HIV-2) were screened for parasitic infections. Twenty five percent of the HIV-2 positive patients were infected with C. parvum, 11% with I. belli and 11% with microsporidia, all three parasites were seen only in HIV-positive patients. The three patients with microsporidiosis, all HIV-2 infected, are to our knowledge the first cases reported from Guinea-Bissau. Other stool parasites such as Blastocystis hominis, hookworm and Strongyloides stercoralis were observed both among HIV-positive and HIV-negative patients.

Sexually transmitted diseases and sexual behaviour as risk factors for HIV-2 infection in Bissau, Guinea Bissau.

Patients enrolled in a hospital-based case control study (n = 1009) and a follow-up study (n = 130) of HIV-2 infection in Bissau were investigated with regard to sexual behaviour and sexually transmitted diseases (STD). A history of genital ulcer was more frequent in HIV-2 infected male patients (46.4%, 13 out of 28) than in seronegative male patients (17.9%, 7 out of 39) (P = 0.05). Serological evidence of a previous syphilitic infection was significantly related to HIV-2 infection (23%, 12 out of 52, of HIV-2 seropositive patients had a positive Treponema pallidum haemagglutination test compared with 7.1%, 5 out of 70, of seronegative patients, P = 0.025) and was equally frequent in men and women. There was no significant difference in number of non-marital sexual partners and frequency of intercourse between HIV-2 seropositive and seronegative individuals. The seroprevalence of HIV-2 infection was significantly higher among patients with a monogamous marriage, 23.1% (59 out of 255) among males and 31.3% (64 out of 204) among females, than among patients with an officially polygamous marriage, 10.3% (8 out of 77) among males and 11.8% (7 out of 59) among females (P = 0.025 for males and 0.005 for females). Infection-control measures directed at patients with STD should be promoted in Guinea-Bissau. Further research on sexual behaviour and attitudes is needed.

Clinical predictors for death in HIV-positive and HIV-negative tuberculosis patients in Guinea-Bissau.

OBJECT: To assess easily monitored predictors for tuberculosis mortality. DESIGN: Risk factors for tuberculosis mortality were assessed during the 8-month treatment in 440 men and 269 women diagnosed with confirmed or presumed intrathoracic tuberculosis included prospectively in Guinea-Bissau from May 1996 to April 2001. A civil war occurred in the study area from June 1998 to May 1999. RESULTS: 12% were HIV-1 positive, 16% HIV-2 positive and 7% were HIV dually infected. Case fatality rates for HIV positive were higher during (35% [22/63]) and after the war (29% [27/92]) compared to before the war (17% [15/88]). The war did not have an effect on the case fatality rate in HIV negative (10% [13/135] before the war). HIV-1-infected patients had higher mortality than HIV-2 infected, mortality rate ratio (MRR) = 2.28 (95% confidence interval 1.17-4.46). Men had higher mortality than women but only among the HIV negative (MRR = 2.09 [0.95-4.59]). Hence, the negative impact of HIV infection on mortality was stronger in women (MRR = 6.51 [2.98-14.2]) than in men (MRR = 2.64 [1.67-4.17]) (test of homogeneity, p = 0.051). Anergy to tuberculin was associated with death in HIV positive (MRR = 2.77 [1.38-5.54]) but not in HIV negative (MRR = 1.14 [0.52-2.53]). Signs of immune deficiency, such as oral candida infection or leukoplakia (MRR = 4.25 [1.92-9.44]) and diarrhea (MRR = 2.15 [1.29-3.58] was associated with mortality in HIV positive. Tendencies were similar among HIV negative. HIV-positive relapse cases were at increased risk of dying (MRR = 2.42 [1.10-5.34]). Malnutrition, measured through mid-upper arm circumference (MUAC), increased the risk of death. CONCLUSION: Easily monitored predictors for mortality in tuberculosis patients include clinical signs of immune deficiency and low MUAC.

HIV-1, HIV-2, HTLV-I/II and Treponema pallidum infections: incidence, prevalence, and HIV-2-associated mortality in an occupational cohort in Guinea-Bissau.

The prevalence and incidence of human immunodeficiency virus types 1 and 2 (HIV-1, HIV-2), human T-lymphotropic virus types I and II (HTLV-I/II), and syphilitic infections and the association between these infections were determined in a cohort of police officers in Guinea-Bissau. Between January 1990 and December 1992, 1,384 subjects (1,241 men and 143 women) were included in the study; and of the first 879 tested, 561 were tested at least for a second time. The overall seroprevalence of HIV-1 was 0.4%, of HIV-2 11.6%, and of HTLV I/II 4.4%. Three individuals (0.2%) were seropositive for both HIV-1 and HIV-2. Women had a significantly higher prevalence of HIV-2 infection than men (16.8% and 11.0%, respectively, p < 0.05). Serologic evidence of previous syphilis was present in 12.1% and was significantly more common in men (12.7%) than in women (7.0%) (p < 0.05). There was a significant association between the prevalence of HIV-2 and HTLV-I/II infection (p < 0.05). The annual incidence of HIV-1 was 0.7%, of HIV-2 1.6%, of HTLV I/II 0.4%, and of syphilis 1.7%. There was no association between the incidence of the various infections. The death rate (per 100 person-years) was significantly higher among HIV-2-infected individuals (2.7%) than among HIV-negative individuals (0.5%) (relative risk = 5.1; 95% confidence interval, 2.1-12.2; p < 0.001). HIV-related symptoms were more frequent among the HIV-2-positive individuals who died compared with the seronegative individuals who died (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)