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Gottlieb GS. Dolutegravir-based Antiretroviral Therapy for Human Immunodeficiency Virus Type 2 (HIV-2) Infection: Progress for People With HIV-2. Clin Infect Dis 2023; 77:749-751. [PMID: 37288974 DOI: 10.1093/cid/ciad340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
- Geoffrey S Gottlieb
- Center for Emerging and Re-Emerging Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Enivormental Health & Safety, University of Washington, Seattle, Washington, USA
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Varanda J, Santos JM. It Was Not the Perfect Storm: The Social History of the HIV-2 Virus in Guinea-Bissau. Trop Med Infect Dis 2023; 8:tropicalmed8050261. [PMID: 37235309 DOI: 10.3390/tropicalmed8050261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
The perfect storm model that was elaborated for the HIV-1M pandemic has also been used to explain the emergence of HIV-2, a second human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) that became an epidemic in Guinea-Bissau, West Africa. The use of this model creates epidemiological generalizations, ecological oversimplifications and historical misunderstandings as its assumptions-an urban center with explosive population growth, a high level of commercial sex and a surge in STDs, a network of mechanical transport and country-wide, en masse mobile campaigns-are absent from the historical record. This model fails to explain how the HIV-2 epidemic actually came about. This is the first study to conduct an exhaustive examination of sociohistorical contextual developments and align them with environmental, virological and epidemiological data. The interdisciplinary dialogue indicates that the emergence of the HIV-2 epidemic piggybacked on local sociopolitical transformations. The war's indirect effects on ecological relations, mobility and sociability were acute in rural areas and are a key to the HIV-2 epidemic. This setting had the natural host of the virus, the population numbers, the mobility trends and the use of technology on a scale needed to foster viral adaptation and amplification. The present analysis suggests new reflections on the processes of zoonotic spillovers and disease emergence.
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Affiliation(s)
- Jorge Varanda
- Centre for Research in Anthropology (CRIA-UC), Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine-NOVA-Lisbon (GHTM-UNL), Rua da Junqueira, 100, 1349-008 Lisboa, Portugal
| | - José Maurício Santos
- Centre for Geographical Studies, Institute of Geography and Spatial Planning, Universidade de Lisboa, 1600-276 Lisboa, Portugal
- Associated Laboratory TERRA, 1349-017 Lisboa, Portugal
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Legrand N, McGregor S, Bull R, Bajis S, Valencia BM, Ronnachit A, Einsiedel L, Gessain A, Kaldor J, Martinello M. Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection. Clin Microbiol Rev 2022; 35:e0007821. [PMID: 35195446 PMCID: PMC8941934 DOI: 10.1128/cmr.00078-21] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.
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Affiliation(s)
- Nicolas Legrand
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Skye McGregor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rowena Bull
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sahar Bajis
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Amrita Ronnachit
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lloyd Einsiedel
- Central Australian Health Service, Alice Springs, Northern Territory, Australia
| | - Antoine Gessain
- Institut Pasteur, Epidemiology and Physiopathology of Oncogenic Viruses Unit, Paris, France
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Ronchetti AM, Matheron S, Galicier L, Damond F, Mahjoub N, Chaghil N, Meignin V, Mechaï F, Simon F, Oksenhendler E, Gérard L. Lymphoma in HIV-2-infected patients in combination antiretroviral therapy era. AIDS 2021; 35:2299-2309. [PMID: 34231524 DOI: 10.1097/qad.0000000000003015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe lymphoma in HIV-2-infected patients and compare their characteristics with lymphoma in HIV-1-infected patients. DESIGN Ancillary analysis from a single center prospective cohort of HIV-lymphoma. METHODS We report on 16 patients with HIV-2-lymphoma diagnosed after 1996 and included in a prospective cohort of HIV lymphoma. Five additional HIV-2-infected patients coinfected with HIV-1 or/and HTLV-I (6 lymphomas) are separately reported. The incidence of lymphoma in HIV-2-infected patients was evaluated in the French multicentric HIV-2 cohort. RESULTS Incidence of lymphoma in the French HIV-2 cohort was estimated as 0.6/1000 patient-years. In our series, the median CD4+ cell count was 166 × 106/l at the time of lymphoma diagnosis and 50% of patients had undetectable plasma HIV-2-RNA. Lymphomas were non-Hodgkin lymphoma (n = 12) and classical Hodgkin lymphoma (n = 4). Similarly to HIV-1-lymphoma, clinical presentation was aggressive in most cases. All but one patient received intensive chemotherapy. Complete remission was achieved in 13 cases and 1 patient relapsed. The overall survival was not statistically different from that observed in patients with HIV-1 lymphoma. The six additional lymphomas observed in five HIV-2-infected patients coinfected with HIV-1 or/and HTLV-I presented with similar clinical presentation but worse prognosis. CONCLUSION Despite the lower pathogenicity of HIV-2, the risk of developing lymphoma seems to be close to that observed in HIV-1 population with similar lymphoma characteristics. Compared with HIV-1, HIV-2-infected patients developed lymphoma later in their life but at a similar CD4+ cell count level.
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Affiliation(s)
- Anne-Marie Ronchetti
- Département d'Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | | | - Lionel Galicier
- Département d'Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | - Florence Damond
- Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris
| | - Nadia Mahjoub
- Laboratoire de Virologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | - Nathalie Chaghil
- INSERM, Université de Bordeaux, CIC 1401, UMR 1219, Bordeaux Population Health Research Center, CHU de Bordeaux
| | - Véronique Meignin
- Laboratoire de Pathologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | - Frédéric Mechaï
- Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny
| | - François Simon
- Laboratoire de Virologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
| | - Eric Oksenhendler
- Département d'Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
- Université Paris-Diderot, Université de Paris, Paris, France
| | - Laurence Gérard
- Département d'Immunologie Clinique, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris
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Marcusso RMN, Van Weyenbergh J, de Moura JVL, Dahy FE, de Moura Brasil Matos A, Haziot MEJ, Vidal JE, Fonseca LAM, Smid J, Assone T, Casseb J, de Oliveira ACP. Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil. Pathogens 2019; 9:pathogens9010025. [PMID: 31888093 PMCID: PMC7168659 DOI: 10.3390/pathogens9010025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/30/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Despite its relatively low incidence of associated diseases, Human T-cell Leukemia Virus-1 (HTLV-1) infection was reported to carry a significant risk of mortality in several endemic areas. HTLV-1-associated diseases, adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraperesis (HAM/TSP), as well as frequent coinfections with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Strongyloides stercoralis were associated to increased morbidity and mortality of HTLV-1 infection. Objective: To determine the mortality rate and its associated variables from an open cohort started in July 1997 at the HTLV Clinic, Emilio Ribas Institute (IIER), a major infectious disease hospital in São Paulo, Brazil. Methods: Since inception up to September 2018, we admitted 727 HTLV-1-infected individuals, with a rate of 30–50 new admissions per year. All patient data, including clinical and laboratory data, were regularly updated throughout the 21-year period, using a dedicated REDCap database. The Ethical Board of IIER approved the protocol. Results: During 21 years of clinical care to people living with HTLV-1 in the São Paulo region, we recruited 479 asymptomatic HTLV-1-infected individuals and 248 HAM/TSP patients, of which 632 remained under active follow-up. During a total of 3800 person-years of follow-up (maximum follow-up 21.5 years, mean follow-up 6.0 years), 27 individuals died (median age of 51.5 years), of which 12 were asymptomatic, one ATLL patient and 14 HAM/TSP patients. HAM/TSP diagnosis (but neither age nor gender) was a significant predictor of increased mortality by univariate and multivariate (hazard ratio (HR) 5.03, 95% CI [1.96–12.91], p = 0.001) Cox regression models. Coinfection with HIV/HCV was an independent predictor of increased mortality (HR 15.08; 95% CI [5.50–41.32]; p < 0.001), with AIDS-related infections as a more frequent cause of death in asymptomatics (6/13; p = 0.033). HIV/HCV-negative fatal HAM/TSP cases were all female, with urinary tract infection and decubitus ulcer-associated sepsis as the main cause of death (8/14, p = 0.002). Conclusions: All-cause mortality among people living with HTLV-1 in São Paulo differs between asymptomatic (2.9%) and HAM/TSP patients (7.3%), independent of age and gender. We observe a dichotomy in fatal cases, with HAM/TSP and HIV/HCV coinfection as independent risk factors for death. Our findings reveal an urgent need for public health actions, as the major causes of death, infections secondary to decubitus ulcers, and immune deficiency syndrome (AIDS)-related infections, can be targeted by preventive measures.
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Affiliation(s)
- Rosa Maria N. Marcusso
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Correspondence: (R.M.N.M.); (A.C.P.d.O.)
| | - Johan Van Weyenbergh
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium;
| | - João Victor Luisi de Moura
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Flávia Esper Dahy
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | | | - Michel E. J. Haziot
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Jose E. Vidal
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
| | - Luiz Augusto M. Fonseca
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
| | - Jerusa Smid
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Tatiane Assone
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, Medical School, University of São Paulo Brazil, São Paulo 05403-000, Brazil
| | - Jorge Casseb
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, Medical School, University of São Paulo Brazil, São Paulo 05403-000, Brazil
| | - Augusto César Penalva de Oliveira
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Correspondence: (R.M.N.M.); (A.C.P.d.O.)
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Kjerulff B, Petersen MS, Rodrigues CM, da Silva Té D, Christiansen M, Erikstrup C, Hønge BL. HTLV infected individuals have increased B-cell activation and proinflammatory regulatory T-cells. Immunobiology 2019; 225:151878. [PMID: 31810824 DOI: 10.1016/j.imbio.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
Human T-lymphotropic virus (HTLV) affects the human immune system in many ways, most notably by inducing proliferation of infected CD4 + T cells, but several other cell types are also affected. To characterize the effects of HTLV infection, we analysed blood samples from HTLV-infected individuals by flow cytometry. Samples were collected from visitors at the HIV clinic in Bissau, Guinea-Bissau. These samples were tested for HTLV and HIV, and 199 were analysed by flow cytometry using panels for B cells, T-cell maturation and activation, regulatory T cells (Tregs) and monocytes. CD80+ cell proportions were significantly higher in HTLV infected than in HTLV uninfected in all B cell subsets. Among T cells, there was no change in cell distribution between maturation stages, but a higher CD25+ proportion among Tregs (61.1 % vs 36.3 %, p < 0.001) in HTLV infected than in HTLV uninfected. The level of CD49d on individual cells was also higher (MFI 2734.5 vs 1,041, p < 0.001). In HTLV infected individuals, CD8 + T cells had a lower proportion of CTLA-4+ (2.5 % vs 3.5 %, 0.048) and higher PD1+ proportion on the CD45RO + subset (81.6 % vs 77.1 %, p < 0.001). Together, these findings point toward reduced regulation in HTLV + patients, which leads to immune activation. This study corroborates previous findings and offers new insight into the effects of HTLV by providing a broad flowcytometric analysis of immune cells in HTLV + individuals.
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Affiliation(s)
- Bertram Kjerulff
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark.
| | - Mikkel Steen Petersen
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark
| | | | | | - Mette Christiansen
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark
| | - Bo Langhoff Hønge
- Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark; Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau; Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Skejby, Denmark
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Schierhout G, McGregor S, Gessain A, Einsiedel L, Martinello M, Kaldor J. Association between HTLV-1 infection and adverse health outcomes: a systematic review and meta-analysis of epidemiological studies. THE LANCET. INFECTIOUS DISEASES 2019; 20:133-143. [PMID: 31648940 DOI: 10.1016/s1473-3099(19)30402-5] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus that causes a lifelong infection. Several diseases, including an aggressive form of leukaemia, have been designated as associated with HTLV-1, whereby having HTLV-1 is a necessary condition for diagnosis. Beyond these diseases, there is uncertainty about other health effects of HTLV-1. We aimed to synthesise evidence from epidemiological studies on associations between health outcomes and HTLV-1. METHODS For this systematic review and meta-analysis, we searched Embase, MEDLINE, MEDLINE In-Process, and Global Health for publications from their inception to July, 2018. We included cohort, case-control, and controlled cross-sectional studies that compared mortality or morbidity between people with and without HTLV-1. We excluded studies of psychiatric conditions, of symptoms or clinical findings only, of people who had undergone blood transfusion or organ transplant, and of population groups defined by a behavioural characteristic putting them at increased risk of co-infection with another virus. We extracted the risk estimates (relative risks [RRs] or odds ratios [ORs]) that reflected the greatest degree of control for potential confounders. We did a random-effects meta-analysis for groups of effect estimates where case ascertainment methods, age groups, and confounders were similar, presenting pooled estimates with 95% CIs and prediction intervals. FINDINGS Of the 3318 identified studies, 39 met the inclusion criteria, examining 42 clinical conditions between them. The adjusted risk of death due to any cause was higher in people with HTLV-1 when compared with HTLV-1-negative counterparts (RR 1·57, 95% CI 1·37-1·80). From meta-analysis, HTLV-1 was associated with increased odds of seborrheic dermatitis (OR 3·95, 95% CI 1·99-7·81), Sjogren's syndrome (3·25, 1·85-5·70), and, inversely, with lower relative risk of gastric cancer (RR 0·45, 0·28-0·71). There were a further 14 diseases with significant associations or substantially elevated risk with HTLV-1 from single studies (eczema [children]; bronchiectasis, bronchitis and bronchiolitis [analysed together]; asthma [males]; fibromyalgia; rheumatoid arthritis; arthritis; tuberculosis; kidney and bladder infections; dermatophytosis; community acquired pneumonia; strongyloides hyperinfection syndrome; liver cancer; lymphoma other than adult T-cell leukaemia-lymphoma; and cervical cancer). INTERPRETATION There is a broad range of diseases studied in association with HTLV-1. However, the elevated risk for death among people with HTLV-1 is not explained by available studies of morbidity. Many of the diseases shown to be associated with HTLV-1 are not fatal, and those that are (eg, leukaemia) occur too rarely to account for the observed mortality effect. There are substantial research gaps in relation to HTLV-1 and cardiovascular, cerebrovascular, and metabolic disease. The burden of disease associated with the virus might be broader than generally recognised. FUNDING Commonwealth Department of Health, Australia.
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Affiliation(s)
- Gill Schierhout
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia; The George Institute for Global Health, Faculty of Medicine, University of New South Wales Newtown, NSW, Australia.
| | - Skye McGregor
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Antoine Gessain
- Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Paris, France; CNRS, UMR3569, Paris, France
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute Central Australia, Alice Springs, NT, Australia
| | - Marianne Martinello
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - John Kaldor
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
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Smith RA, Raugi DN, Wu VH, Zavala CG, Song J, Diallo KM, Seydi M, Gottlieb GS. Comparison of the Antiviral Activity of Bictegravir against HIV-1 and HIV-2 Isolates and Integrase Inhibitor-Resistant HIV-2 Mutants. Antimicrob Agents Chemother 2019; 63:e00014-19. [PMID: 30803972 PMCID: PMC6496081 DOI: 10.1128/aac.00014-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 02/22/2019] [Indexed: 12/16/2022] Open
Abstract
We compared the activity of the integrase inhibitor bictegravir against HIV-1 and HIV-2 using a culture-based, single-cycle assay. Values of 50% effective concentrations ranged from 1.2 to 2.5 nM for 9 HIV-1 isolates and 1.4 to 5.6 nM for 15 HIV-2 isolates. HIV-2 integrase mutants G140S/Q148R and G140S/Q148H were 34- and 110-fold resistant to bictegravir, respectively; other resistance-associated mutations conferred ≤5-fold changes in bictegravir susceptibility. Our findings indicate that bictegravir-based antiretroviral therapy should be evaluated in HIV-2-infected individuals.
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Affiliation(s)
- Robert A Smith
- Center for Emerging and Reemerging Infectious Diseases and Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Dana N Raugi
- Center for Emerging and Reemerging Infectious Diseases and Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Vincent H Wu
- Center for Emerging and Reemerging Infectious Diseases and Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Christopher G Zavala
- Center for Emerging and Reemerging Infectious Diseases and Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Jennifer Song
- Center for Emerging and Reemerging Infectious Diseases and Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | | | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, CHNU de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Center for Emerging and Reemerging Infectious Diseases and Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Jensen MM, Olesen JS, Kjerulff B, Byberg S, da Silva ZJ, Rodrigues A, Jespersen S, Wejse C, Aaby P, Erikstrup C, Hønge BL. HTLV prevalence is no longer following the decreasing HIV prevalence - 20 years of retroviral surveillance in Guinea-Bissau, West Africa. Acta Trop 2019; 192:144-150. [PMID: 30771284 DOI: 10.1016/j.actatropica.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 02/09/2019] [Accepted: 02/12/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND The HIV-2 and HTLV-1 prevalences in Bissau have followed similar trends in surveys from 1996 and 2006 with HTLV-1 prevalences of 3.6% and 2.3%, respectively. However, following the introduction of antiretroviral treatment (ART) and informative campaigns about HIV, the epidemics may have shifted. To evaluate the current HTLV prevalence and the continued association with HIV, we performed a third survey. METHODS A cross-sectional survey was performed from November 2014 to February 2016. In total, 2583 participants were interviewed, tested for HIV, and had blood samples collected. Samples were analysed for anti-HTLV using chemiluminescence and immunoblot assays. We calculated the HTLV prevalence for 2016 and examined risk factors for HTLV and associations with HIV using binominal regression. RESULTS The prevalence of HTLV was 2.8% (71/2583), 1.5% (16/1,089) for men and 3.7% (55/1,494) for women. Old age, female sex, HIV-2 infection and sharing a house with a HTLV- infected person were strong risk factors for HTLV. In contrast to previous studies, we found a non-significant increase in prevalence among the 15-24 year-olds since 2006, supporting ongoing transmission. CONCLUSIONS The HTLV prevalence in Bissau showed a non-significant increase. We found evidence supporting continuous vertical and horizontal routes of transmissions.
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Esbjörnsson J, Månsson F, Kvist A, da Silva ZJ, Andersson S, Fenyö EM, Isberg PE, Biague AJ, Lindman J, Palm AA, Rowland-Jones SL, Jansson M, Medstrand P, Norrgren H. Long-term follow-up of HIV-2-related AIDS and mortality in Guinea-Bissau: a prospective open cohort study. Lancet HIV 2018; 6:S2352-3018(18)30254-6. [PMID: 30392769 DOI: 10.1016/s2352-3018(18)30254-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/24/2018] [Accepted: 09/06/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND HIV type 2 (HIV-2) is considered more benign and has fewer pathogenic consequences than HIV type 1 (HIV-1) for most infected individuals. However, reliable estimates of time to AIDS and mortality among those with HIV-2 infection are absent. We therefore aimed to compare the time to AIDS and mortality, and the CD4 T-cell dynamics between those infected with HIV-1 and HIV-2. METHODS We did a prospective open cohort study. We included all police officers with regular employment from police stations in both urban and rural areas of Guinea-Bissau since Feb 6, 1990. We continued to include participants until Sept 28, 2009, and follow-up of HIV-1-positive and HIV-2-positive individuals continued until Sept 28, 2013. We collected blood samples at enrolment and at scheduled annual follow-up visits at police stations. We analysed longitudinal data from individuals infected with HIV-1 and HIV-2 according to time to AIDS, time to death, and T-cell dynamics. Time of HIV infection was estimated as the mid-timepoint between last HIV-seronegative and first HIV-seropositive sample. Data from an additional 2984 HIV-uninfected individuals from the same population were analysed to assess the effect of natural mortality on HIV-related mortality. FINDINGS 872 participants tested HIV positive during the 23-year study period: 408 were infected with HIV-1 (183 infected before and 225 infected after enrolment) and 464 were infected with HIV-2 (377 before and 87 after enrolment). The median time from HIV infection to development of AIDS was 6·2 years (95% CI 5·4-7·1) for HIV-1 infection and 14·3 years (10·7-18·0) for HIV-2 infection (p<0·0001). The median survival time after HIV infection was 8·2 years (95% CI 7·5-8·9) for HIV-1 infection and 15·6 years (12·0-19·2) for HIV-2 infection (p<0·0001). Individuals who were infected with HIV-1 or HIV-2 before enrolment showed similar results. Comparison with uninfected individuals indicated limited confounding contribution from natural mortality. Mean CD4 percentages were higher in individuals with HIV-2 than in those with HIV-1 during early infection (28·0% [SE 1·3] vs 22·3% [1·7]; p=0·00094) and declined at a slower rate (0·4% [0·2] vs 0·9% [0·2] per year; p=0·028). HIV-2-infected individuals developed clinical AIDS at higher mean CD4 percentages (18·2%, IQR 7·2-25·4) than HIV-1-infected individuals (8·2%, 3·0-13·8; p<0·0001). INTERPRETATION Our results show that both HIV-1-infected and HIV-2-infected individuals have a high probability of developing and dying from AIDS without antiretroviral treatment. FUNDING Swedish International Development Agency, Swedish Research Council, Swedish Society of Medical Research, Medical Faculty at Lund University, and Region Skåne Research and Development.
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Affiliation(s)
- Joakim Esbjörnsson
- Department of Laboratory Medicine, Lund University, Malmö, Sweden; Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Fredrik Månsson
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Anders Kvist
- Department of Clinical Sciences Lund, Lund University, Malmö, Sweden
| | | | - Sören Andersson
- Department of Laboratory Medicine, Örebro University, Örebro, Sweden
| | - Eva Maria Fenyö
- Department of Laboratory Medicine, Lund University, Malmö, Sweden
| | - Per-Erik Isberg
- Department of Statistics, Lund University School of Economics and Management, Lund, Sweden
| | | | - Jacob Lindman
- Department of Clinical Sciences Lund, Lund University, Malmö, Sweden
| | - Angelica A Palm
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | | | - Marianne Jansson
- Department of Laboratory Medicine, Lund University, Malmö, Sweden
| | - Patrik Medstrand
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Hans Norrgren
- Department of Clinical Sciences Lund, Lund University, Malmö, Sweden
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In Vitro Antiviral Activity of Cabotegravir against HIV-2. Antimicrob Agents Chemother 2018; 62:AAC.01299-18. [PMID: 30012774 DOI: 10.1128/aac.01299-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/12/2018] [Indexed: 02/08/2023] Open
Abstract
We examined the antiviral activity of the integrase inhibitor (INI) cabotegravir against HIV-2 isolates from INI-naive individuals. HIV-2 was sensitive to cabotegravir in single-cycle and spreading-infection assays, with 50% effective concentrations (EC50s) in the low to subnanomolar range; comparable results were obtained for HIV-1 in both assay formats. Our findings suggest that cabotegravir should be evaluated in clinical trials as a potential option for antiretroviral therapy and preexposure prophylaxis in HIV-2-prevalent settings.
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Pseudotyping of HIV-1 with Human T-Lymphotropic Virus 1 (HTLV-1) Envelope Glycoprotein during HIV-1-HTLV-1 Coinfection Facilitates Direct HIV-1 Infection of Female Genital Epithelial Cells: Implications for Sexual Transmission of HIV-1. mSphere 2018; 3:3/2/e00038-18. [PMID: 29624497 PMCID: PMC5885023 DOI: 10.1128/msphere.00038-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/14/2018] [Indexed: 11/20/2022] Open
Abstract
Female genital epithelial cells cover the genital tract and provide the first line of protection against infection with sexually transmitted pathogenic viruses. These cells normally are impervious to HIV-1. We report that coinfection of cells by HIV-1 and another sexually transmitted virus, human T-lymphotropic virus 1 (HTLV-1), led to production of HIV-1 that had expanded cell tropism and was able to directly infect primary vaginal and cervical epithelial cells. HIV-1 infection of epithelial cells was blocked by neutralizing antibodies against the HTLV-1 envelope (Env) protein, indicating that the infection was mediated through HTLV-1 Env pseudotyping of HIV-1. Active replication of HIV-1 in epithelial cells was demonstrated by inhibition with anti-HIV-1 drugs. We demonstrated that HIV-1 derived from peripheral blood of HIV-1-HTLV-1-coinfected subjects could infect primary epithelial cells in an HTLV-1 Env-dependent manner. HIV-1 from subjects infected with HIV-1 alone was not able to infect epithelial cells. These results indicate that pseudotyping of HIV-1 with HTLV-1 Env can occur in vivo Our data further reveal that active replication of both HTLV-1 and HIV-1 is required for production of pseudotyped HIV-1. Our findings indicate that pseudotyping of HIV-1 with HTLV-1 Env in coinfected cells enabled HIV-1 to directly infect nonpermissive female genital epithelial cells. This phenomenon may represent a risk factor for enhanced sexual transmission of HIV-1 in regions where virus coinfection is common.IMPORTANCE Young women in certain regions of the world are at very high risk of acquiring HIV-1, and there is an urgent need to identify the factors that promote HIV-1 transmission. HIV-1 infection is frequently accompanied by infection with other pathogenic viruses. We demonstrate that coinfection of cells by HIV-1 and HTLV-1 can lead to production of HIV-1 pseudotyped with HTLV-1 Env that is able to directly infect female genital epithelial cells both in vitro and ex vivo Given the function of these epithelial cells as genital mucosal barriers to pathogenic virus transmission, the ability of HIV-1 pseudotyped with HTLV-1 Env to directly infect female genital epithelial cells represents a possible factor for increased risk of sexual transmission of HIV-1. This mechanism could be especially impactful in settings such as Sub-Saharan Africa and South America, where HIV-1 and HTLV-1 are both highly prevalent.
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Einsiedel L, Pham H, Wilson K, Walley R, Turpin J, Bangham C, Gessain A, Woodman RJ. Human T-Lymphotropic Virus type 1c subtype proviral loads, chronic lung disease and survival in a prospective cohort of Indigenous Australians. PLoS Negl Trop Dis 2018. [PMID: 29529032 PMCID: PMC5874075 DOI: 10.1371/journal.pntd.0006281] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Human T-Lymphotropic Virus type 1c subtype (HTLV-1c) is highly endemic to central Australia where the most frequent complication of HTLV-1 infection in Indigenous Australians is bronchiectasis. We carried out a prospective study to quantify the prognosis of HTLV-1c infection and chronic lung disease and the risk of death according to the HTLV-1c proviral load (pVL). Methodology/Principal findings 840 Indigenous adults (discharge diagnosis of bronchiectasis, 154) were recruited to a hospital-based prospective cohort. Baseline HTLV-1c pVL were determined and the results of chest computed tomography and clinical details reviewed. The odds of an association between HTLV-1 infection and bronchiectasis or bronchitis/bronchiolitis were calculated, and the impact of HTLV-1c pVL on the risk of death was measured. Radiologically defined bronchiectasis and bronchitis/bronchiolitis were significantly more common among HTLV-1-infected subjects (adjusted odds ratio = 2.9; 95% CI, 2.0, 4.3). Median HTLV-1c pVL for subjects with airways inflammation was 16-fold higher than that of asymptomatic subjects. There were 151 deaths during 2,140 person-years of follow-up (maximum follow-up 8.13 years). Mortality rates were higher among subjects with HTLV-1c pVL ≥1000 copies per 105 peripheral blood leukocytes (log-rank χ2 (2df) = 6.63, p = 0.036) compared to those with lower HTLV-1c pVL or uninfected subjects. Excess mortality was largely due to bronchiectasis-related deaths (adjusted HR 4.31; 95% CI, 1.78, 10.42 versus uninfected). Conclusion/Significance Higher HTLV-1c pVL was strongly associated with radiologically defined airways inflammation and with death due to complications of bronchiectasis. An increased risk of death due to an HTLV-1 associated inflammatory disease has not been demonstrated previously. Our findings indicate that mortality associated with HTLV-1c infection may be higher than has been previously appreciated. Further prospective studies are needed to determine whether these results can be generalized to other HTLV-1 endemic areas. The Human T-Lymphotropic Virus type 1 (HTLV-1) infects up to 20 million people worldwide who predominantly reside in resource-limited areas. The virus is associated with a haematological malignancy (adult T-cell leukaemia/lymphoma, ATL), and inflammatory diseases involving organ systems including the spinal cord, eyes and lungs. Determining the outcomes of infection in most HTLV-1 endemic areas is extremely difficult; however, the virus is highly endemic to central Australia where the Indigenous population has access to sophisticated medical facilities. We prospectively followed a large hospital-based cohort of Indigenous Australian adults that was well characterized with regard to base-line comorbid conditions, HTLV-1 serostatus and HTLV-1 proviral load (pVL). A higher baseline HTLV-1 pVL was strongly associated with an increased risk of airway inflammation (bronchitis/bronchiolitis and bronchiectasis) and death, which most often resulted from complications of bronchiectasis. Increased mortality due to an HTLV-1-associated inflammatory condition has not been demonstrated previously. The morbidity and mortality associated with HTLV-1 infection may therefore be substantially higher than has been assumed from an analysis of cohorts of subjects with adult T-cell leukaemia or HTLV-1-associated myelopathy. These findings have important implications for epidemiological research and for determining health care priorities in resource-limited settings.
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Affiliation(s)
- Lloyd Einsiedel
- Aboriginal Health Domain, Baker Heart and Diabetes Institute central Australia, Alice Springs Hospital, Alice Springs, Australia
- * E-mail:
| | - Hai Pham
- Aboriginal Health Domain, Baker Heart and Diabetes Institute central Australia, Alice Springs Hospital, Alice Springs, Australia
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, Australia
| | - Rebecca Walley
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Alice Springs, Australia
| | - Jocelyn Turpin
- Section of Virology, Division of Infectious Diseases, Department of Medicine, Imperial College London, Norfolk Place, London, United Kingdom
| | - Charles Bangham
- Section of Virology, Division of Infectious Diseases, Department of Medicine, Imperial College London, Norfolk Place, London, United Kingdom
| | - Antoine Gessain
- Institut Pasteur, Unité d’Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Paris, France, CNRS UMR 3569
| | - Richard J. Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, Australia
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Chang M, Steinmetzer K, Raugi DN, Smith RA, Ba S, Sall F, Seydi M, Niang A, Sall EI, Cisse O, Rödel K, Coombs RW, Gottlieb GS. Detection and differentiation of HIV-2 using the point-of-care Alere q HIV-1/2 Detect nucleic acid test. J Clin Virol 2017; 97:22-25. [PMID: 29096389 DOI: 10.1016/j.jcv.2017.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 10/18/2017] [Accepted: 10/23/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Alere q HIV-1/2 Detect test (Alere Detect) is a rapid point-of-care (POC) nucleic acid test (NAT) that can detect and differentiate HIV-1 and HIV-2 in 25-μL whole blood or plasma samples. The Alere Detect test has been validated for early infant diagnosis of HIV-1 infection, and it is the only POC NAT device currently known to detect HIV-2, which is endemic in West Africa. OBJECTIVES To evaluate the sensitivity detecting HIV-2 RNA and the differential performance of the Alere Detect. STUDY DESIGN Plasma samples from non-HIV (n=4), HIV-1 (n=22), HIV-2 (n=111; 29 Group A, 2 Group B) and HIV-1/HIV-2 dually-seropositive (n=8) participants in Senegal and the United States and HIV-2 reference strains (3 Group A, 1 Group B) were tested by Alere Detect, Abbott RealTime HIV-1 and the University of Washington HIV-2 RNA quantitative (UW HIV-2) assays. RESULTS The Alere Detect correctly differentiated between HIV-1 and HIV-2 in all 80 (100%) patient samples with detectable HIV RNA (n=20 HIV-1, 60 HIV-2). The overall HIV-2 detection concordance between Alere Detect and the UW HIV-2 assay was 68% (54/80); the concordance improved to 100% (30/30) for samples with HIV-2 RNA >300copies/mL. Neither assay detected HIV-2 RNA in 31 of 111 HIV-2 seropositive samples. CONCLUSIONS The Alere Detect test is a novel device detecting HIV RNA in clinical samples, and differentiating HIV-1 and HIV-2 with a high level of specificity. It has the potential for use as a rapid HIV-2 NAT-based diagnosis tool in resource-limited settings and to confirm HIV-2 infection for the CDC 4th generation HIV-1/2 diagnostic algorithm.
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Affiliation(s)
- Ming Chang
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
| | | | - Dana N Raugi
- Department of Medicine/Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Robert A Smith
- Department of Medicine/Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Selly Ba
- Service des Maladies Infectieuses, CHNU de Fann, Dakar, Senegal
| | - Fatima Sall
- Service des Maladies Infectieuses, CHNU de Fann, Dakar, Senegal
| | - Moussa Seydi
- Service des Maladies Infectieuses, CHNU de Fann, Dakar, Senegal
| | | | | | | | | | - Robert W Coombs
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA; Department of Medicine/Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - Geoffrey S Gottlieb
- Department of Medicine/Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
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15
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Mendoza CD, Requena S, Caballero E, Cabezas T, Peñaranda M, Amengual MJ, Sáez A, Lozano AB, Ramos JM, Soriano V. Antiretroviral treatment of HIV-2 infection. Future Virol 2017. [DOI: 10.2217/fvl-2017-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HIV-2 is a neglected virus despite estimates of 1–2 million people being infected worldwide. AIDS develops more slowly in HIV-2 than HIV-1. Outside endemic regions, HIV-2 is mostly found in immigrants from west Africa or their sex partners. There are four major caveats when treating HIV-2. First, some antiretrovirals are not or only partially active against HIV-2. Second, CD4 declines in HIV-2 occur slowly, but CD4 recovery is smaller with antiretroviral treatment. Third, both virological failure and rapid emergence of drug resistance occur more frequently in HIV-2 than HIV-1. Finally, misdiagnosis of HIV-2 in patients wrongly considered as infected with HIV-1 or in those dually infected may result in treatment failures with undetectable HIV-1 RNA. Integrase inhibitors, and especially dolutegravir, should be part of any preferred HIV-2 antiretroviral combination nowadays.
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Affiliation(s)
- Carmen de Mendoza
- Laboratory of Internal Medicine, Puerta de Hierro Research Institute, Majadahonda, Spain
| | - Silvia Requena
- Laboratory of Internal Medicine, Puerta de Hierro Research Institute, Majadahonda, Spain
| | | | | | - María Peñaranda
- Microbiology Unit, Son Espases Hospital, Palma de Mallorca, Spain
| | | | - Ana Sáez
- Microbiology Unit, Hospital Marqués de Valdecilla, Santander, Spain
| | | | - José M Ramos
- Infectious Diseases Unit, General Hospital, Alicante, Spain
| | - Vincent Soriano
- Infectious Diseases Unit, La Paz University Hospital & Autonomous University, Madrid, Spain
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Tchounga B, Ekouevi DK, Balestre E, Dabis F. Mortality and survival patterns of people living with HIV-2. Curr Opin HIV AIDS 2016; 11:537-544. [PMID: 27254747 PMCID: PMC5055442 DOI: 10.1097/coh.0000000000000299] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW People living with HIV-2 infected usually initiate antiretroviral therapy (ART) at an advanced period in the course of their infection after a long asymptomatic period characterized by high CD4 cell count and thus at a relatively advanced age. In the new international context of early and universal ART initiation, the aim was to review survival patterns among HIV-2 infected patients, either on ART or not. RECENT FINDINGS Very few reports were published on mortality in people living with HIV-2 during the last 5 years. People living with HIV-2 experience high mortality rates although lower than people living with HIV-1 before ART initiation. They seem to survive longer regardless of the conditions of ART use. Mortality is associated with late presentation, male sex, CD4 cell count less than 500 cell/μl, high plasma viral load, hemoglobin rate less than 8 g/dl and body mass index less than 18 kg/m. SUMMARY People living with HIV-2 initiate ART later than HIV-1 and HIV duals, resulting in higher disease progression and mortality rate. The clinical management of HIV-2 infected patients should now include early diagnosis and treatment initiation as per international guidelines. Further research needs to explore the 'what to start' question and document specific causes of death in people living with HIV-2 and enrolled in care in Africa.
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Affiliation(s)
- Boris Tchounga
- aUniversité de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population HealthbProgramme PACCI, site de recherche ANRS, Abidjan, Côte d'IvoirecDépartement de Santé Publique, Université de Lomé, Lomé-Togo
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Usadi B, Bruhn R, Lin J, Lee TH, Blackburn E, Murphy EL. Telomere Length, Proviral Load and Neurologic Impairment in HTLV-1 and HTLV-2-Infected Subjects. Viruses 2016; 8:v8080221. [PMID: 27529270 PMCID: PMC4997583 DOI: 10.3390/v8080221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 12/27/2022] Open
Abstract
Short or damaged telomeres have been implicated in degenerative conditions. We hypothesized that analysis of telomere length (TL) in human T-cell lymphotropic virus (HTLV) infection and HTLV-associated neuropathy might provide clues to the etiology of HTLV-associated disease and viral dynamics. A subset of 45 human T-cell lymphotropic virus type 1 (HTLV-1), 45 human T-cell lymphotropic virus type 2 (HTLV-2), and 45 seronegative subjects was selected from the larger HTLV Outcomes Study (HOST) cohort, matched on age, sex and race/ethnicity. Telomere-to-single-copy gene (T/S) ratio (a measure of TL) and HTLV-1 and HTLV-2 proviral loads were measured in peripheral blood mononuclear cells (PBMCs) using quantitative PCR (qPCR). Vibration sensation measured by tuning fork during neurologic examinations performed as part of the HOST study allowed for an assessment of peripheral neuropathy. TL was compared between groups using t-tests, linear and logistic regression. Mean T/S ratio was 1.02 ± 0.16 in HTLV-1, 1.03 ± 0.17 in HTLV-2 and 0.99 ± 0.18 in HTLV seronegative subjects (p = 0.322). TL was not associated with HTLV-1 or -2 proviral load. Shorter TL was significantly associated with impaired vibration sense in the HTLV-2 positive group only. Overall, we found no evidence that telomere length was affected by chronic HTLV-1 and HTLV-2 infection. That TL was only associated with peripheral neuropathy in the HTLV-2-positive group is intriguing, but should be interpreted cautiously. Studies with larger sample size and telomere length measurement in lymphocyte subsets may clarify the relationship between TL and HTLV-infection.
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Affiliation(s)
- Benjamin Usadi
- School of Public Health, University of California Berkeley, Berkeley, CA 94720-7360, USA.
| | - Roberta Bruhn
- Blood Systems Research Institute, San Francisco, CA 94118, USA.
| | - Jue Lin
- Departments of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA 94158, USA.
| | - Tzong-Hae Lee
- Blood Systems Research Institute, San Francisco, CA 94118, USA.
| | - Elizabeth Blackburn
- Departments of Biochemistry and Biophysics, University of California San Francisco, San Francisco, CA 94158, USA.
- Salk Institute for Biological Studies, La Jolla, CA 92037, USA.
| | - Edward L Murphy
- Blood Systems Research Institute, San Francisco, CA 94118, USA.
- Laboratory Medicine, University of California San Francisco, San Francisco, CA 94158, USA.
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA.
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Mortality rates in people dually infected with HIV-1/2 and those infected with either HIV-1 or HIV-2: a systematic review and meta-analysis. AIDS 2014; 28:549-58. [PMID: 23921613 DOI: 10.1097/01.spc.0000432532.87841.78] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE As compared to HIV-1 infection, HIV-2 is less transmissible, disease progression is slower, and the mortality risk is lower. It has been suggested that HIV-2 infection inhibits the progression of HIV-1 in individuals dually infected by HIV-1 and HIV-2 (HIV-D). We examined whether the mortality rates in dually infected individuals differ from those in persons infected with either HIV-1 or HIV-2. DESIGN We conducted a systematic review and meta-analysis. METHODS Medline and Embase databases were searched for studies that reported the number of deaths and person-years of observation (PY) for at least two of the three HIV groups (i.e. HIV-1, HIV-2, and HIV-D). Meta-analyses were then performed with random-effects models, estimating combined mortality rate ratios (MRRs). RESULTS Of the 631 identified titles, six articles were included in the meta-analysis of HIV-D-infected individuals versus HIV-mono-infected persons, and seven were included in the analysis of HIV-1-mono-infected versus HIV-2-mono-infected individuals. The overall MRR of those infected with HIV-D versus HIV-1 was 1.11 [95% confidence interval (CI) 0.95-1.30]. The overall MRR of those infected with HIV-D versus HIV-2 was 1.81 (95% CI 1.43-2.30) and the MRR of those infected with HIV-1 versus HIV-2 was 1.86 (95% CI 1.44-2.39). CONCLUSION HIV-2-mono-infected persons have a lower mortality rate than those mono-infected with HIV-1 and those with HIV-D. There is no evidence that HIV-2 delays progression to death in HIV-D-infected individuals.
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Einsiedel L, Spelman T, Goeman E, Cassar O, Arundell M, Gessain A. Clinical associations of Human T-Lymphotropic Virus type 1 infection in an indigenous Australian population. PLoS Negl Trop Dis 2014; 8:e2643. [PMID: 24454973 PMCID: PMC3894183 DOI: 10.1371/journal.pntd.0002643] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/01/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION In resource-poor areas, infectious diseases may be important causes of morbidity among individuals infected with the Human T-Lymphotropic Virus type 1 (HTLV-1). We report the clinical associations of HTLV-1 infection among socially disadvantaged Indigenous adults in central Australia. METHODOLOGY AND PRINCIPAL FINDINGS HTLV-1 serological results for Indigenous adults admitted 1(st) January 2000 to 31(st) December 2010 were obtained from the Alice Springs Hospital pathology database. Infections, comorbid conditions and HTLV-1 related diseases were identified using ICD-10 AM discharge morbidity codes. Relevant pathology and imaging results were reviewed. Disease associations, admission rates and risk factors for death were compared according to HTLV-1 serostatus. HTLV-1 western blots were positive for 531 (33.3%) of 1595 Indigenous adults tested. Clinical associations of HTLV-1 infection included bronchiectasis (adjusted Risk Ratio, 1.35; 95% CI, 1.14-1.60), blood stream infections (BSI) with enteric organisms (aRR, 1.36; 95% CI, 1.05-1.77) and admission with strongyloidiasis (aRR 1.38; 95% CI, 1.16-1.64). After adjusting for covariates, HTLV-1 infection remained associated with increased numbers of BSI episodes (adjusted negative binomial regression, coefficient, 0.21; 95% CI, 0.02-0.41) and increased admission numbers with strongyloidiasis (coefficient, 0.563; 95% CI, 0.17-0.95) and respiratory conditions including asthma (coefficient, 0.99; 95% CI, 0.27-1.7), lower respiratory tract infections (coefficient, 0.19; 95% CI, 0.04-0.34) and bronchiectasis (coefficient, 0.60; 95% CI, 0.02-1.18). Two patients were admitted with adult T-cell Leukemia/Lymphoma, four with probable HTLV-1 associated myelopathy and another with infective dermatitis. Independent predictors of mortality included BSI with enteric organisms (aRR 1.78; 95% CI, 1.15-2.74) and bronchiectasis (aRR 2.07; 95% CI, 1.45-2.98). CONCLUSION HTLV-1 infection contributes to morbidity among socially disadvantaged Indigenous adults in central Australia. This is largely due to an increased risk of other infections and respiratory disease. The spectrum of HTLV-1 related diseases may vary according to the social circumstances of the affected population.
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Affiliation(s)
- Lloyd Einsiedel
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
- SAPathology, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
- * E-mail:
| | - Tim Spelman
- Flinders University/Northern Territory Rural Clinical School, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Emma Goeman
- Remote Health, Alice Springs, Northern Territory, Australia
| | - Olivier Cassar
- Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Paris, France
- CNRS, UMR 3569, Paris, France
| | - Mick Arundell
- Clinical Information Analyst, Central Australian Health Network, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Antoine Gessain
- Institut Pasteur, Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Département de Virologie, Paris, France
- CNRS, UMR 3569, Paris, France
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Evidence from the field: missed opportunities for identifying and linking HIV-infected children for early initiation of ART. AIDS 2013; 27 Suppl 2:S139-46. [PMID: 24361623 DOI: 10.1097/qad.0000000000000101] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Raugi DN, Gottlieb GS, Sow PS, Toure M, Sall F, Gaye A, N’doye I, Kiviat NB, Hawes SE. HIV-1 outcompetes HIV-2 in dually infected Senegalese individuals with low CD4⁺ cell counts. AIDS 2013; 27:2441-50. [PMID: 23665777 PMCID: PMC4043222 DOI: 10.1097/qad.0b013e328362e856] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Dual infection with HIV-1 and HIV-2, which is not uncommon in West Africa, has implications for transmission, progression, and antiretroviral therapy (ART). Few studies have examined viral dynamics in this setting. Our objective was to directly compare HIV-1 and HIV-2 viral loads and to examine whether this relationship is associated with CD4⁺ cell count. STUDY DESIGN This is a retrospective analysis of data from observational cohort studies. METHODS We compared HIV-1 and HIV-2 viral loads from 65 dually infected, ART-naive Senegalese individuals. Participants provided blood, oral fluid, and cervicovaginal lavage (CVL) or semen samples for virologic and immunologic testing. We assessed relationships between HIV-1 and HIV-2 levels using linear regression with generalized estimating equations to account for multiple study visits. RESULTS After adjusting for CD4⁺ cell count, age, sex, and commercial sex work, HIV-1 RNA levels were significantly higher than HIV-2 levels in semen, CVL, and oral fluids. Despite similar peripheral blood mononuclear cell DNA levels among individuals with CD4⁺ cell counts above 500 cells/μl, individuals with CD4⁺ cell counts below 500 cells/μl had higher HIV-1 and lower HIV-2 DNA levels. Individuals with high CD4⁺ cell counts had higher mean HIV-1 plasma RNA viral loads than HIV-2, with HIV-1 levels significantly higher and HIV-2 levels trending toward lower mean viral loads among individuals with low CD4⁺ cell counts. CONCLUSION Our data are consistent with the hypothesis that with disease progression, HIV-1 outcompetes HIV-2 in dually infected individuals. This finding helps explain differences in prevalence and outcomes between HIV-1, HIV-2, and HIV-dual infection.
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Affiliation(s)
- Dana N. Raugi
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Geoffrey S. Gottlieb
- Department of Medicine, Division of Allergy and Infectious Diseases, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Papa S. Sow
- Clinique des Maladies Infectieuses Ibrahima DIOP Mar, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Macoumba Toure
- Clinique des Maladies Infectieuses Ibrahima DIOP Mar, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Fatima Sall
- Clinique des Maladies Infectieuses Ibrahima DIOP Mar, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - Awa Gaye
- Department of Dentistry, Centre Hospitalier Universitaire de Fann, Universite Cheikh Anta Diop de Dakar, Dakar, Senegal
| | | | - Nancy B. Kiviat
- Department of Pathology, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Stephen E. Hawes
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
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Ekouevi DK, Balestre E, Coffie PA, Minta D, Messou E, Sawadogo A, Minga A, Sow PS, Bissagnene E, Eholie SP, Gottlieb GS, Dabis F. Characteristics of HIV-2 and HIV-1/HIV-2 Dually Seropositive Adults in West Africa Presenting for Care and Antiretroviral Therapy: The IeDEA-West Africa HIV-2 Cohort Study. PLoS One 2013; 8:e66135. [PMID: 23824279 PMCID: PMC3688850 DOI: 10.1371/journal.pone.0066135] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/01/2013] [Indexed: 11/26/2022] Open
Abstract
Background HIV-2 is endemic in West Africa. There is a lack of evidence-based guidelines on the diagnosis, management and antiretroviral therapy (ART) for HIV-2 or HIV-1/HIV-2 dual infections. Because of these issues, we designed a West African collaborative cohort for HIV-2 infection within the framework of the International epidemiological Databases to Evaluate AIDS (IeDEA). Methods We collected data on all HIV-2 and HIV-1/HIV-2 dually seropositive patients (both ARV-naive and starting ART) and followed-up in clinical centres in the IeDEA-WA network including a total of 13 clinics in five countries: Benin, Burkina-Faso Côte d’Ivoire, Mali, and Senegal, in the West Africa region. Results Data was merged for 1,754 patients (56% female), including 1,021 HIV-2 infected patients (551 on ART) and 733 dually seropositive for both HIV-1 and HIV 2 (463 on ART). At ART initiation, the median age of HIV-2 patients was 45.3 years, IQR: (38.3–51.7) and 42.4 years, IQR (37.0–47.3) for dually seropositive patients (p = 0.048). Overall, 16.7% of HIV-2 patients on ART had an advanced clinical stage (WHO IV or CDC-C). The median CD4 count at the ART initiation is 166 cells/mm3, IQR (83–247) among HIV-2 infected patients and 146 cells/mm3, IQR (55–249) among dually seropositive patients. Overall, in ART-treated patients, the CD4 count increased 126 cells/mm3 after 24 months on ART for HIV-2 patients and 169 cells/mm3 for dually seropositive patients. Of 551 HIV-2 patients on ART, 5.8% died and 10.2% were lost to follow-up during the median time on ART of 2.4 years, IQR (0.7–4.3). Conclusions This large multi-country study of HIV-2 and HIV-1/HIV-2 dual infection in West Africa suggests that routine clinical care is less than optimal and that management and treatment of HIV-2 could be further informed by ongoing studies and randomized clinical trials in this population.
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Affiliation(s)
- Didier K. Ekouevi
- Université Bordeaux Segalen, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
- Programme PACCI, Abidjan, Côte d’Ivoire
- Département des Sciences Fondamentales et Santé Publique, Université de Lomé, Lomé, Togo
- * E-mail:
| | - Eric Balestre
- Université Bordeaux Segalen, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
| | - Patrick A. Coffie
- Programme PACCI, Abidjan, Côte d’Ivoire
- Département de Dermatologie et Infectiologie, UFR Sciences Médicales, Université Félix-Houphouët Boigny, Abidjan, Côte d’Ivoire
| | - Daouda Minta
- Centre de Prise en Charge des Personnes vivant avec le VIH, Hôpital du Point G, Bamako, Mali
| | - Eugene Messou
- Programme PACCI, Abidjan, Côte d’Ivoire
- Département de Dermatologie et Infectiologie, UFR Sciences Médicales, Université Félix-Houphouët Boigny, Abidjan, Côte d’Ivoire
- ACONDA-CePReF Adultes, Abidjan, Côte d’Ivoire
| | - Adrien Sawadogo
- Hôpital de jour, CHU Souro Sanou, Bobo Dioulasso, Burkina-Faso
| | - Albert Minga
- Centre Médical de Suivi de Donneurs de Sang, Projet PRIMO-CI, Abidjan, Côte d’Ivoire
| | - Papa Salif Sow
- Service des Maladies Infectieuses et Tropicales, CHU de Fann, Dakar, Sénégal
| | - Emmanuel Bissagnene
- Département de Dermatologie et Infectiologie, UFR Sciences Médicales, Université Félix-Houphouët Boigny, Abidjan, Côte d’Ivoire
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Serge P. Eholie
- Département de Dermatologie et Infectiologie, UFR Sciences Médicales, Université Félix-Houphouët Boigny, Abidjan, Côte d’Ivoire
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d’Ivoire
| | - Geoffrey S. Gottlieb
- Departments of Medicine and Global Health, University of Washington, Seattle, Washington, United States of America
| | - François Dabis
- Université Bordeaux Segalen, ISPED, Centre INSERM U897- Epidémiologie-Biostatistique, Bordeaux, France
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van Tienen C, Schim van der Loeff M, Whittle H. Effect of HIV-2 infection on HIV-1 disease progression. N Engl J Med 2012; 367:1962; author reply 1962-3. [PMID: 23150973 DOI: 10.1056/nejmc1210334] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Heitzinger K, Sow PS, Dia Badiane NM, Gottlieb GS, N'Doye I, Toure M, Kiviat NB, Hawes SE. Trends of HIV-1, HIV-2 and dual infection in women attending outpatient clinics in Senegal, 1990-2009. Int J STD AIDS 2012; 23:710-6. [PMID: 23104745 PMCID: PMC3726192 DOI: 10.1258/ijsa.2012.011219] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed trends in the relative prevalences of HIV-1, HIV-2 and dual HIV-1/HIV-2 infection in 10,321 women attending outpatient clinics in Senegal between 1990 and 2009. The relative prevalence of HIV-1 (defined as the proportion of seropositive subjects having HIV-1) rose sharply from 38% in 1990 until 1993 (P < 0.001), whereupon it continued to rise, but at a slower rate, reaching 72% of HIV infections in 2009. As compared with HIV-1, the relative prevalence of HIV-2 decreased sharply from 54% in 1990 until 1993 (P < 0.001) and continued to decrease at a slower rate through 2009. The relative prevalence of dual infection, as compared with HIV-1, was stable from 1990 to 1993, but decreased slightly thereafter (P < 0.001). These study findings indicate that during the early 1990s, the relative prevalence of HIV-1 increased markedly, while the relative prevalence of HIV-2 decreased and the relative prevalence of dual infection remained stable in Senegal. From 1993 to 2009, the relative prevalence of HIV-1 increased at a slower rate, while the relative prevalences of HIV-2 and dual infection decreased. These results confirm trends in HIV prevalence observed in other West African populations and provide a critical update on HIV transmission risk among women in Senegal.
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Affiliation(s)
- K Heitzinger
- Department of Epidemiology, School of Public Health, University of Washington, Box 357236, Seattle, WA 98195, USA.
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