title: Parenteral transmission during excision and treatment of tuberculosis and trypanosomiasis may be responsible for the HIV-2 epidemic in Guinea-Bissau.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Microbiology and Infectious Diseases and Center for International Health, Centre Hospitalier Universitaire 3001, University of Sherbrooke, 12th Avenue North, Sherbrooke, Quebec, Canada. jacques.pepin@usherbrooke.edu
authors.forename: Jacques
authors.initials: J
authors.lastname: Pépin
authors.forename: Mireille
authors.initials: M
authors.lastname: Plamondon
authors.forename: Alfredo Claudino
authors.initials: AC
authors.lastname: Alves
authors.forename: Mélissa
authors.initials: M
authors.lastname: Beaudet
authors.forename: Annie-Claude
authors.initials: AC
authors.lastname: Labbé
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000818:Animals; D019093:Circumcision, Female; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D018562:Disease Transmission, Infectious; D004866:Equipment Contamination; D005006:Ethnicity; D005247:Feeding Behavior; D005260:Female; D006169:Guinea-Bissau; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology / Q000635:transmission*; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects; D008297:Male; D008393:Marriage; D008875:Middle Aged; D008992:Monkey Diseases / Q000635:transmission; D009339:Needles; D016017:Odds Ratio; D015995:Prevalence; D012737:Sex Factors; D012725:Sexual Behavior; D013997:Time Factors; D014352:Trypanosomiasis / Q000188:drug therapy* / Q000601:surgery; D014376:Tuberculosis / Q000188:drug therapy*; D015047:Zoonoses