title: Iatrogenic transmission of human T cell lymphotropic virus type 1 and hepatitis C virus through parenteral treatment and chemoprophylaxis of sleeping sickness in colonial Equatorial Africa.
abstract: BACKGROUND
  The simultaneous emergence of human immunodeficiency virus (HIV)-1 group M and HIV-2 into human populations, circa 1921-1940, is attributed to urbanization and changes in sexual behavior. We hypothesized that the initial dissemination of HIV-1, before sexual transmission predominated, was facilitated by the administration, via reusable syringes and needles, of parenteral drugs against tropical diseases. As proxies for highly lethal HIV-1, we investigated risk factors for hepatitis C virus (HCV) and human T cell lymphotropic virus 1 (HTLV-1) infections, blood-borne viruses compatible with prolonged survival, in an area known in 1936-1950 as the most virulent focus of African trypanosomiasis.
  
  
  METHODS
  Cross-sectional survey of individuals 55 years and older in Mbimou land and Nola, Central African Republic. Dried blood spots were used for HCV and HTLV-1 serologic testing and nucleic acid detection. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were measured by logistic regression.
  
  
  RESULTS
  The only risk factor for HCV genotype 4 infection was treatment of trypanosomiasis before 1951 (OR, 3.13; 95% CI, 1.38-7.09). HTLV-1 infection was associated with having received 2 injections of pentamidine for trypanosomiasis chemoprophylaxis (adjusted OR, 2.03; 95% CI, 1.01-4.06) and with transfusions (adjusted OR, 2.82; 95% CI, 1.04-7.67). From historical data, we predicted that 59% of Mbimous 65 years and older would report treatment for trypanosomiasis before 1951; only 11% did so.
  
  
  CONCLUSIONS
  Treatment of trypanosomiasis before 1951 may have caused iatrogenic HCV transmission. Population-wide half-yearly intramuscular pentamidine for trypanosomiasis chemoprophylaxis in 1947-1953 may have caused iatrogenic HTLV-1 transmission. These and other interventions against tropical diseases could have iatrogenically transmitted SIV(cpz), jump-starting the HIV-1 epidemic. The excess mortality among patients with trypanosomiasis treated before 1951 supports this hypothesis.
authors.affiliation: Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Quebec, Canada. jacques.pepin@usherbrooke.ca
authors.forename: Jacques
authors.initials: J
authors.lastname: Pépin
authors.forename: Annie-Claude
authors.initials: AC
authors.lastname: Labbé
authors.forename: Fleurie
authors.initials: F
authors.lastname: Mamadou-Yaya
authors.forename: Pascal
authors.initials: P
authors.lastname: Mbélesso
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Mbadingaï
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deslandes
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Locas
authors.forename: Eric
authors.initials: E
authors.lastname: Frost
mesh_terms: D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D002488:Central African Republic / Q000453:epidemiology; D018890:Chemoprevention / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D015490:HTLV-I Infections / Q000635:transmission*; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000635:transmission*; D015368:Human T-lymphotropic virus 1 / Q000276:immunology; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007275:Injections, Intravenous / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D014353:Trypanosomiasis, African / Q000188:drug therapy* / Q000517:prevention & control*
chemical_list: D000914:Antibodies, Viral; D000981:Antiprotozoal Agents