title: Epidemic History and Iatrogenic Transmission of Blood-borne Viruses in Mid-20th Century Kinshasa.
abstract: BACKGROUND
  The human immunodeficiency virus type 1 (HIV-1) pandemic was ignited in Léopoldville (now known as Kinshasa), in the former Belgian Congo. Factors that jump-started its early expansion remain unclear. Nonlethal hepatitis C virus (HCV) and human T-cell lymphotropic virus (HTLV-1) can be used to investigate past iatrogenic transmission.
  
  
  METHODS
  We undertook a cross-sectional study of elderly inhabitants of Kinshasa, with serological assays, amplification, and sequencing. Risk factors were assessed through logistic regression. Phylogenetic methods reconstructed the genetic history of HCV.
  
  
  RESULTS
  A total of 217 of 839 participants (25.9%) were HCV seropositive; 26 (3.1%) were HTLV-1-seropositive. Amplification products were obtained from 118 HCV-seropositive participants; subtypes 4k (in 47 participants) and 4r (in 38) were most common. Independent risk factors for HCV subtype 4r seropositivity were intramuscular tuberculosis therapy, intravenous injections at hospital A, intravenous injections before 1960, and injections at a colonial-era venereology clinic. Intravenous injections at hospital B and antimalarials were associated with HCV subtype 4k seropositivity. Risk factors for HTLV-1 seropositivity included intravenous injections at hospitals C or D and transfusions. Evolutionary analysis of viral sequences revealed independent exponential amplification of HCV subtypes 4r and 4k from the 1950s onward.
  
  
  CONCLUSIONS
  Iatrogenic transmission of HCV and HTLV-1 occurred in mid-20th century Kinshasa, at the same time and place HIV-1 emerged. Iatrogenic routes may have contributed to the early establishment of the pandemic.
authors.affiliation: Université de Sherbrooke, Canada.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Hogan
authors.affiliation: University of Oxford.
authors.forename: James
authors.initials: J
authors.lastname: Iles
authors.affiliation: Université de Sherbrooke, Canada.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Frost
authors.affiliation: Université de Sherbrooke, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Giroux
authors.affiliation: Institut Pasteur Centre National de la Recherche Scientifique, UMR 3569, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Cassar
authors.affiliation: Institut Pasteur Centre National de la Recherche Scientifique, UMR 3569, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Gessain
authors.affiliation: Université de Sherbrooke, Canada.
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Dion
authors.affiliation: Programme ESP/UNC-DRC.
authors.forename: Vicky
authors.initials: V
authors.lastname: Ilunga
authors.affiliation: University of Edinburgh, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Rambaut
authors.affiliation: Université de Kinshasa, Democratic Republic of the Congo.
authors.forename: André-Édouard
authors.initials: AÉ
authors.lastname: Yengo-Ki-Ngimbi
authors.affiliation: Programme ESP/UNC-DRC University of North Carolina, Chapel Hill.
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
authors.affiliation: University of Oxford.
authors.forename: Oliver G
authors.initials: OG
authors.lastname: Pybus
authors.affiliation: Université de Sherbrooke, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Pépin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D018562:Disease Transmission, Infectious; D005260:Female; D015490:HTLV-I Infections / Q000453:epidemiology / Q000635:transmission*; D006526:Hepatitis C / Q000453:epidemiology / Q000635:transmission*; D049673:History, 20th Century; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016036:Seroepidemiologic Studies; D014777:Virus Diseases / Q000453:epidemiology* / Q000266:history / Q000635:transmission*
keywords: Democratic Republic of the Congo; HCV; HIV-1; HTLV-1; Kinshasa; iatrogenic transmission