Emmanuel Gnaore

Risk of tuberculosis in patients with HIV-I and HIV-II infections in Abidjan, Ivory Coast.

OBJECTIVE--To examine the association between HIV-II infection and tuberculosis. DESIGN--Cross sectional study comparing the prevalence of HIV-I and HIV-II infections in patients with tuberculosis and in blood donors. SETTING--Abidjan, Ivory Coast, west Africa. PATIENTS--2043 consecutive ambulant patients with tuberculosis (confirmed pulmonary, presumed pulmonary, or extrapulmonary) and 2127 volunteer blood donors. MAIN OUTCOME MEASURE--Prevalence of HIV-I and HIV-II infections as assessed by presence of serum antibodies. RESULTS--Overall rates of HIV infection were 40.2% in patients with tuberculosis (26.4% positive for HIV-I, 4.7% for HIV-II, and 9.0% for both); and 10.4% in blood donors (7.2% positive for HIV-I, 1.9% for HIV-II, and 1.3% for both). HIV-II infection was significantly more common in patients with all types of tuberculosis than in blood donors (97/2043, 4.7% v 40/2127, 1.9%; odds ratio 3.8%, 95% confidence interval 2.6 to 5.6). CONCLUSION--Both HIV-I and HIV-II infections are associated with tuberculosis in Abidjan. 35% of adult tuberculosis in Abidjan is attributable to HIV infection and 4% specifically to HIV-II.

A comparison of clinical features in tuberculosis associated with infection with human immunodeficiency viruses 1 and 2.

Between July 1989 and December 1990, 4504 new adult patients with tuberculosis were screened for antibodies to human immunodeficiency viruses (HIV) 1 and 2 in Abidjans 2 tuberculosis treatment centres. The prevalence levels of HIV-1 and HIV-2 infections were 30.2% and 4.2% respectively, a further 9.3% of patients reacting serologically to both viruses. Patients in all 3 seropositive groups differed significantly from seronegatives in having a higher frequency of AIDS-related features such as wasting, chronic diarrhoea, oral candidiasis and generalized lymphadenopathy. These data support earlier work showing an association between HIV-2 infection and similar opportunistic diseases which complicate HIV-1 infection, including tuberculosis. Despite the differences between seropositive and seronegative groups, symptoms and signs of tuberculosis may mimic those of AIDS. HIV testing should be more widely available for the clinical care of tuberculosis patients in Africa, as well as for epidemiological surveillance.

Dual seroreactivity to HIV-1 and HIV-2 in female sex workers in Abidjan, Côte d'Ivoire

ObjectiveTo determine the absolute, and proportional prevalence of dual seroreactivity to HIV-1, and HIV-2 in female sex workers in Abidjan, to determine risk determinants for this serologic profile, and to describe the associated clinical, and immunological characteristics. DesignCross-sectional study. SettingConfidential clinic for female sex workers in Abidjan. ParticipantsFemale sex workers. Main outcome measuresHIV serostatus, CD4+ counts, women with AIDS, behavioural, and sociodemographic characteristics. ResultsAmong 1209 women tested, the overall HIV seroprevalence was 80%, while the prevalence of dual seroreactivity was 30%. Dual seroreactivity accounted for 38% of all HIV infections. Compared with women reacting to HIV-1 only, dually seroreactive women were significantly more likely to have been in sex work for a longer period, to be aged ≥20 years, and to charge less money for intercourse. No difference in mean CD4+ count was noted between women with dual seroreactivity (561±106/l), and HIV-1 -seropositive women (588 ± 106/l). ConclusionsFemale sex workers in Abidjan had the highest absolute (30%), and proportional rate (38%) of dual seroreactivity yet described in any population. Increased sexual exposure is associated with an increased risk of dual seroreactivity. Although better molecular diagnostic techniques are required, a substantial proportion of female sex workers in Abidjan is likely to be infected with both HIV-1, and HIV-2.

PREVALENCE OF AND MORTALITY FROM HIV TYPE 2 IN GUINEA BISSAU, WEST AFRICA

This letter to the editor challenges the conclusion by Dr. Poulsen and his colleagues (Apr. 15 p. 827) from their study of Guinea-Bissau that perinatal transmission of human immunodeficiency virus type II (HIV-2) is rare or absent. A 20-month-old boy admitted for malnutrition and diarrhea with abnormally straight and fragile hair and generalized lymphadenopathy tested positive for HIV-2 and negative for human immunodeficiency virus type I (HIV-1) antibodies. His mother 31 who had never travelled outside the Ivory Coast had amenorrhea weight loss and generalized lymphadenopathy; she also tested positive for HIV-2 and negative for HIV-1 antibodies. A sister 7 also with generalized lymphadenopathy showed HIV-2 infection. 2 healthy siblings 13 and 10 were HIV-negative. The husband who was tested but not examined showed antibodies to both HIV-1 and HIV-2 but the tests do not prove dual infection. This family cluster supports reports that HIV-2 may be transmitted from mother to child and suggests the HIV-2 infection has existed in the Ivory Coast for at least 7 years. Another report described antibodies to HIV-2 found in samples collected in the Ivory Coast in 1966. Hence conclusions about perinatal transmission should be drawn with caution pending results of prospective studies.