Parenteral transmission during excision and treatment of tuberculosis and trypanosomiasis may be responsible for the HIV-2 epidemic in Guinea-Bissau

AIDS. 2006 Jun 12;20(9):1303-11. doi: 10.1097/01.aids.0000232239.05545.33.


Background and objective: The factors that led to the simultaneous emergence, decades ago, of HIV-1 in central Africa and HIV-2 in West Africa remain unclear. The low HIV-2-associated mortality enables epidemiological assessment of risk factors potentially relevant in the early stages of the epidemic. In Guinea-Bissau, its epicentre, HIV-2 became highly prevalent (approximately 15%) in cohorts of individuals born before 1962, but is now disappearing whereas HIV-1 prevalence is increasing. We sought to verify the hypothesis that parenteral transmission was the key factor in the building-up of the HIV-2 epidemic.

Design: Cross-sectional community survey of 1608 individuals aged > or = 50 years in Bissau.

Methods: Capillary blood was obtained for HIV serology. Associations between HIV-2 (alone or in dual HIV-1/HIV-2 infections) and exposures were measured with crude and adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Results: Prevalence of HIV-2 was higher in women (160/1063; 15.1%) than men (45/545; 8.3%, P < 0.001). Among women, excision (AOR, 1.54; 95% CI, 1.08-2.18) was independently associated with HIV-2, as were age and being widowed (AOR, 1.88; 95% CI, 1.29-2.74). Among men, HIV-2 was not associated with sexually transmitted infections or transactional sex. In an analysis comprising men and women that was adjusted for age, sex, ethnic group and marital status, HIV-2 was associated with having received injections for the treatment of tuberculosis (AOR, 2.12; 95% CI, 1.11-4.05) or trypanosomiasis (AOR, 1.75; 95% CI, 1.03-2.97).

Conclusions: Parenteral transmission through ritual excision and multiple injections during treatment of tuberculosis and trypanosomiasis contributed to the emergence of HIV-2 in Guinea-Bissau.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Animals
  • Circumcision, Female
  • Cross-Sectional Studies
  • Disease Outbreaks
  • Disease Transmission, Infectious
  • Equipment Contamination
  • Ethnicity
  • Feeding Behavior
  • Female
  • Guinea-Bissau
  • HIV Infections / epidemiology
  • HIV Infections / ethnology
  • HIV Infections / transmission*
  • HIV-1*
  • HIV-2*
  • Humans
  • Injections, Intravenous / adverse effects
  • Male
  • Marriage
  • Middle Aged
  • Monkey Diseases / transmission
  • Needles
  • Odds Ratio
  • Prevalence
  • Sex Factors
  • Sexual Behavior
  • Time Factors
  • Trypanosomiasis / drug therapy*
  • Trypanosomiasis / surgery
  • Tuberculosis / drug therapy*
  • Zoonoses