Mortality associated with HIV-1, HIV-2, and HTLV-I single and dual infections in a middle-aged and older population in Guinea-Bissau

Birgitta Holmgren,Pernille Vastrup,Sören Andersson,Zacarias Da Silva,Olav Larsen,Peter Aaby,Henrik Ravn

doi:10.1186/1742-4690-4-85

Birgitta Holmgren, Pernille Vastrup + Show 5 more

Open Access

https://doi.org/10.1186/1742-4690-4-85

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Abstract

BackgroundIn Guinea-Bissau HIV-1, HIV-2, and HTLV-I are prevalent in the general population. The natural history of HIV/HTLV-I single and dual infections has not been fully elucidated in this population. Previous studies have shown that combinations of these infections are more common in older women than in men. The present study compares mortality associated with HIV-1, HIV-2, and HTLV-I single and dual infections in individuals over 35 years of age within an urban community-based cohort in Guinea-Bissau.ResultsA total of 2,839 and 1,075 individuals were included in the HIV and HTLV-I mortality analyses respectively. Compared with HIV-negative individuals, adjusted mortality rate ratios (MRRs) were 4.9 (95% confidence interval (CI): 2.3, 10.4) for HIV-1, 1.8 (95%CI: 1.5, 2.3) for HIV-2, and 5.9 (2.4, 14.3) for HIV-1/HIV-2 dual infections. MRR for HTLV-I-positive compared with HTLV-I-negative individuals was 1.7 (1.1, 2.7). Excluding all HIV-positive individuals from the analysis, the HTLV-I MRR was 2.3 (1.3, 3.8). The MRR of HTLV-I/HIV-2 dually infected individuals was 1.7 (0.7, 4.3), compared with HIV/HTLV-I-negative individuals. No statistically significant differences were found in retrovirus-associated mortality between men and women.ConclusionHIV-1-associated excess mortality was low compared with community studies from other parts of Africa, presumably because this population was older and the introduction of HIV-1 into the community recent. HIV-2 and HTLV-I-associated mortality was 2-fold higher than the mortality in uninfected individuals. We found no significant differences between the mortality risk for HIV-2 and HTLV-I single infection, respectively, and HIV-2/HTLV-I dual infection. The higher prevalence of retroviral dual infections in older women is not explained by differential retrovirus-associated mortality for men and women.

Highlights

In Guinea-Bissau HIV-1, HIV-2, and HTLV-I are prevalent in the general population
When we considered both HIV-1 single infection and dual infections as HIV-1 infection, individuals = 45, though the differences were not statistically significant (Table 5)
The mortality rate ratios (MRRs) for dual HIV-1/HIV-2 infection in our study was more equivalent to the risk we found for HIV-1 and could

Summary

Introduction

In Guinea-Bissau HIV-1, HIV-2, and HTLV-I are prevalent in the general population. The natural history of HIV/HTLV-I single and dual infections has not been fully elucidated in this population. The present study compares mortality associated with HIV-1, HIV-2, and HTLV-I single and dual infections in individuals over 35 years of age within an urban communitybased cohort in Guinea-Bissau. In a rural population aged 15 years and over in the same country, we found a strong association between HIV-2 and HTLV-I in women but not in men [7]. Few studies have investigated mortality associated with HIV-1/HIV-2 dual infection [9,10], and it is unclear whether there are any differences between men and women. There are few studies addressing HTLV-I-associated mortality in a general population in Africa [4,19]

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