title: Male Circumcision and the Epidemic Emergence of HIV-2 in West Africa.
abstract: BACKGROUND
  Epidemic HIV-2 (groups A and B) emerged in humans circa 1930-40. Its closest ancestors are SIVsmm infecting sooty mangabeys from southwestern Côte d'Ivoire. The earliest large-scale serological surveys of HIV-2 in West Africa (1985-91) show a patchy spread. Côte d'Ivoire and Guinea-Bissau had the highest prevalence rates by then, and phylogeographical analysis suggests they were the earliest epicenters. Wars and parenteral transmission have been hypothesized to have promoted HIV-2 spread. Male circumcision (MC) is known to correlate negatively with HIV-1 prevalence in Africa, but studies examining this issue for HIV-2 are lacking.
  
  
  METHODS
  We reviewed published HIV-2 serosurveys for 30 cities of all West African countries and obtained credible estimates of real prevalence through Bayesian estimation. We estimated past MC rates of 218 West African ethnic groups, based on ethnographic literature and fieldwork. We collected demographic tables specifying the ethnic partition in cities. Uncertainty was incorporated by defining plausible ranges of parameters (e.g. timing of introduction, proportion circumcised). We generated 1,000 sets of past MC rates per city using Latin Hypercube Sampling with different parameter combinations, and explored the correlation between HIV-2 prevalence and estimated MC rate (both logit-transformed) in the 1,000 replicates.
  
  
  CONCLUSIONS
  Our survey reveals that, in the early 20th century, MC was far less common and geographically more variable than nowadays. HIV-2 prevalence in 1985-91 and MC rates in 1950 were negatively correlated (Spearman rho = -0.546, IQR: -0.553--0.546, p≤0.0021). Guinea-Bissau and Côte d'Ivoire cities had markedly lower MC rates. In addition, MC was uncommon in rural southwestern Côte d'Ivoire in 1930.The differential HIV-2 spread in West Africa correlates with different historical MC rates. We suggest HIV-2 only formed early substantial foci in cities with substantial uncircumcised populations. Lack of MC in rural areas exposed to bushmeat may have had a role in successful HIV-2 emergence.
authors.affiliation: KU Leuven-University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, B-3000, Leuven, Belgium.|Center for Global Health and Tropical Medicine, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: João Dinis
authors.identifier: http://orcid.org/0000-0002-7604-3109
authors.initials: JD
authors.lastname: Sousa
authors.affiliation: Department of Natural Resources, Environment, and Land, CEF, School of Agriculture, University of Lisbon, Lisbon, Portugal.
authors.forename: Marina Padrão
authors.identifier: http://orcid.org/0000-0002-8254-4233
authors.initials: MP
authors.lastname: Temudo
authors.affiliation: Department of Anthropology, Washington State University Vancouver, Vancouver, Washington, United States of America.
authors.forename: Barry Stephen
authors.initials: BS
authors.lastname: Hewlett
authors.affiliation: KU Leuven-University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, B-3000, Leuven, Belgium.
authors.forename: Ricardo Jorge
authors.initials: RJ
authors.lastname: Camacho
authors.affiliation: Institute of Biology, Eötvös Loránd University, Budapest, Hungary.|Parmenides Center for the Conceptual Foundations of Science, Pullach/Munich, Germany.
authors.forename: Viktor
authors.identifier: http://orcid.org/0000-0001-8212-4880
authors.initials: V
authors.lastname: Müller
authors.affiliation: KU Leuven-University of Leuven, Department of Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, B-3000, Leuven, Belgium.|Center for Global Health and Tropical Medicine, Unidade de Microbiologia Médica, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Anne-Mieke
authors.identifier: http://orcid.org/0000-0002-6594-2766
authors.initials: AM
authors.lastname: Vandamme
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000821:virology; D000818:Animals; D016665:Cercocebus atys / Q000821:virology; D002944:Circumcision, Male / Q000379:methods; D007560:Cote d'Ivoire / Q000453:epidemiology; D003906:Developing Countries; D058872:Epidemics; D006169:Guinea-Bissau / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity; D015498:HIV-2 / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D058974:Phylogeography / Q000379:methods; D015995:Prevalence