HTLV-1 and HIV-2 Infection Are Associated with Increased Mortality in a Rural West African Community

Abstract

BackgroundSurvival of people with HIV-2 and HTLV-1 infection is better than that of HIV-1 infected people, but long-term follow-up data are rare. We compared mortality rates of HIV-1, HIV-2, and HTLV-1 infected subjects with those of retrovirus-uninfected people in a rural community in Guinea-Bissau.MethodsIn 1990, 1997 and 2007, adult residents (aged ≥15 years) were interviewed, a blood sample was drawn and retroviral status was determined. An annual census was used to ascertain the vital status of all subjects. Cox regression analysis was used to estimate mortality hazard ratios (HR), comparing retrovirus-infected versus uninfected people.ResultsA total of 5376 subjects were included; 197 with HIV-1, 424 with HIV-2 and 325 with HTLV-1 infection. The median follow-up time was 10.9 years (range 0.0–20.3). The crude mortality rates were 9.6 per 100 person-years of observation (95% confidence interval 7.1-12.9) for HIV-1, 4.1 (3.4–5.0) for HIV-2, 3.6 (2.9–4.6) for HTLV-1, and 1.6 (1.5–1.8) for retrovirus-negative subjects. The HR comparing the mortality rate of infected to that of uninfected subjects varied significantly with age. The adjusted HR for HIV-1 infection varied from 4.0 in the oldest age group (≥60 years) to 12.7 in the youngest (15–29 years). The HR for HIV-2 infection varied from 1.2 (oldest) to 9.1 (youngest), and for HTLV-1 infection from 1.2 (oldest) to 3.8 (youngest).ConclusionsHTLV-1 infection is associated with significantly increased mortality. The mortality rate of HIV-2 infection, although lower than that of HIV-1 infection, is also increased, especially among young people.

Update on HIV-1 and HIV-2 Dual Infection

“…Finally, infection with both HIV-1 and HIV-2 generally carries the same prognosis and a similar mortality rate as HIV-1, except one study in rural community in Gambia which reported lower mortality among HIV-2-infected patients (van Tienen et al 2011). Two studies in Guinea-Bissau found conflicting results: (1) among 285 HIV-2-and 53 dual-infected patients, there found no difference in mortality with follow-up to 19 years in rural Caio (van Tienen et al 2011), and (2) among 223 patients that included 32 dually infected (14.3 %), it was suggested that being infected with HIV-1 and HIV-2 is associated to a slower rate of disease progression particularly in patients in whom HIV-2 infection preceded HIV-1 infection.…”

“…Two studies in Guinea-Bissau found conflicting results: (1) among 285 HIV-2-and 53 dual-infected patients, there found no difference in mortality with follow-up to 19 years in rural Caio (van Tienen et al 2011), and (2) among 223 patients that included 32 dually infected (14.3 %), it was suggested that being infected with HIV-1 and HIV-2 is associated to a slower rate of disease progression particularly in patients in whom HIV-2 infection preceded HIV-1 infection. These observations in a cohort with a long follow-up (approximately 20 years) showed that HIV-2 has an inhibitory effect of the rate of HIV-1 disease progression (Esbjornsson et al 2012).…”

“…This entry provides information on the epidemiology, diagnosis, and clinical manifestations of dual HIV seropositivity, presenting the treatment options for these patients. Holmgren et al 2003;van der Loeff et al 2006;van Tienen et al 2011). It is not clear whether social factors, biological factors, or both account for the less worldwide spread of HIV-2.…”

Human Immunodeficiency Viruses Types 1 and 2

“…The largest and most reliable estimates of mortality probably come from a study of deaths due to serologically confi rmed HIV-1, HIV-2, and HTLV-I infections among more than 5,000 residents of a rural area in northwestern Guinea-Bissau [ 50 ]. The study spanned the 18-year period before ART became available in 2007.…”

“…3 ), the most reliable mortality statistics probably come from Guinea-Bissau, where median survival with HIV-2 infection during the 18-year period before ART became available in 2007 was signifi cantly decreased compared with survival of uninfected individuals but approximately twice as long as in individuals with HIV-1 infection [ 50 ]. More on the reciprocal infl uences can be found in Sect.…”