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Thesis Was Financially Supported by the Stichting Sarphati and the Medical Researchh Council UvA-DARE (Digital Academic Repository) HIV-2 in West Africa. Epidemiological studies Schim van der Loeff, M.F. Publication date 2003 Document Version Final published version Link to publication Citation for published version (APA): Schim van der Loeff, M. F. (2003). HIV-2 in West Africa. Epidemiological studies. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:07 Oct 2021 JÉfoo JïP^h V V HIV-2lm m EPIDEMIOLOGICAL L MAARTENN F. SCHIM VAN DER LOEFF HIV-22 IN WEST AFRICA EPIDEMIOLOGICALL STUDIES Printingg of this thesis was financially supported by the Stichting Sarphati and the Medical Researchh Council. ISBNN 90-6464-834-4 Printedd by Ponsen & Looi jen - Wageningen Coverr design: Casper Schim van der Loeff - Utrecht ©© 2003 by M. F. Schim van der Loeff, London, UK. All rights reserved. No part of this publicationn may be reproduced or transmitted in any form or by any means, electronic or mechanical,, including photocopy, recording, or any information storage or retrieval system,, without permission from the copyright owner. Copyrights of chapters 2, 3, 5, 6, 88 are transferred to Lippincott Williams & Wilkins. These chapters are reprinted with kindd permission from Lippincott Williams & Wilkins. HIV-22 in West Africa Epidemiologicall Studies ACADEMISCHH PROEFSCHRIFT terr verkrijging van de graad van doctor aann de Universiteit van Amsterdam opp gezag van de Rector Magnificus prof.. mr. P. F. van der Heijden tenn overstaan van een door het college voor promoties ingestelde commissie,, in het openbaar te verdedigen in de Aula der Universiteit opp woensdag 26 november 2003, te 12:00 uur. doorr Maarten Francis cus Schim van der Loef f geborenn te Venray Promotiecommiss sie Promotores:: Prof. dr. R. A. Coutinho Prof.. dr. P. Aaby Co-promotor:: Prof. H. C. Whittle Overigee leden: Prof. dr. F. Miedema Prof.. dr. J. M. A. Lange Prof.. dr. P. A. Kager Prof.. dr. M. W. Borgdorff Prof.. dr. A. D. M. E. Osterhaus Prof.. dr. G.J. Bonsel Faculteitt der Geneeskunde Voorr vader en moeder 'Enn nu nog iets,' zei Kaatje Kater toen Buitenrust Hettema en Wiegel in Rotterdam de treinn verlaten hadden en ze met zijn drieën in de coupé waren achtergebleven. 'Hoe staat hett met je proefschrift?' Ze keek hem indringend aan. Hett was zo onverwacht dat Maarten niet meteen een antwoord had. Hij schudde langzaamm zijn hoofd, zonder iets te zeggen. 'Hett wordt nu wel echt tijd.1 'Ikk ben daar nog niet aan toe.' 'Enn wanneer kom je er dan aan toe? Want als je te lang wacht, is het te laat.' Beertaa glimlachte heimelijk. 'Ikk ben daar niet bang voor. Ik vind dat je pas een proefschrift moet schrijven als je daarinn gelooft.' J.J.J.J. Voskuil, Plankton, Het Bureau deel 3 Contents s Chapterr 1 Introduction 11 Chapterr 2 Towards a better understanding of the epidemiology of HIV-2 19 Chapterr 3 Regional differences in HIV trends in The Gambia: results from 59 sentinell surveillance among pregnant women Chapterr 4 Incidence of HIV-2 in a rural community in Guinea-Bissau, West 73 Africa a Chapterr 5 HIV-2 does not protect against HIV-1 infection in a rural 89 communityy in Guinea-Bissau Chapterr 6 Mortality of HIV-1, HIV-2 and HIV-1 / HIV-2 dually infected 107 patientss in a clinic-based cohort in The Gambia, West Africa Chapterr 7 Contrasts in plasma viral load, CD4% and survival in a community- 129 basedd cohort of HIV-1 and HIV-2 infected women in The Gambia Chapterr 8 Survival of HIV-1 and HIV-2 perinatally infected children in The 147 Gambia a Chapterr 9 Conclusions 161 Listt of Abbreviations 183 Summaryy 185 Samenvattingg 189 Listt of publications 193 CVV 197 Acknowledgementss 199 1 1 Introduction n HIV-22 IN WEST AFRICA Inn 1986, three years after the discovery of HIV-1, another retrovirus was identified, and namedd HIV-2 [1,2]. It was isolated from West African patients with AIDS and its discoveryy caused concern that another devastating epidemic was at hand. Various researchh groups in West Africa started to study the epidemiology, risk factors and the naturall history of this infection. The Medical Research Council Laboratories, a research institutee based in The Gambia since 1947, initiated studies on HIV-2 in 1988 and made importantt findings on the descriptive epidemiology [3-7], risk factors for infection [8-10], clinicall course and mortality [11-13], immune response [14-17] and viral load [18]. The underlyingg strategy has been to compare HIV-1 and HIV-2 infections. Whenn I joined the MRC in 1995,1 was able to build on the work of my predecessors and colleagues,, who had established three cohorts: a hospital-based cohort, a community- basedd cohort of a village with a high prevalence of HIV-2, and a cohort of women recruitedd during pregnancy. This thesis reports on the epidemiological studies carried outt in these three cohorts between 1995 and 2001. Thee studies were carried out in two countries in West Africa, The Gambia and Guinea- Bissau.. This part of die world was known to early European settiers as the White Man's Grave,, mainly due to malaria and yellow fever. It certainly is a Black Man's Grave as well,, as the high infant and maternal mortality ratios, and the low life expectancies testify (seee Table 1). Poor health and poverty are closely associated; the populations in both countriess are among the poorest in the world. Poverty does not merely mean low incomes,, but also poor education, poor roads, poor communications, poor electricity supply,, and poor water supply. This affects not only the population, but also makes researchh efforts in these countries challenging. In Table 1 some key characteristics of bothh countries are listed, together with those of my native Netherlands, to put these in perspective. Thee first study of this thesis was not conducted in any of the existing cohorts, but was a cross-sectionall study (Chapter 3). The Gambia did not have HIV sentinel surveillance untill 1999, so the government and MRC Laboratories joined forces to start this. The 13 3 HIV-22 IN WEST AFRICA Tabtee 1. Key indicators of The Gambia, Guinea-Bissau, and The Netherlands Guinea-- The e Thee Gambia Bissau u Netherlands s Areaa (km^) 11,000 0 36,000 0 42,000 0 Populationn (millions) 1.4 4 1.3 3 16.0 0 Populationn density (people per km2) 125 5 36 6 385 5 GNPP per capita (PPP US$) 1,649 9 755 5 25,657 7 Overseass Development Aid (Euros per 26 6 44 4 -203* * inhabitantt p.a.) UNDPP Human Development Index 2002 0.405 5 0.349 9 0.935 5 Rankk on Human Development List 2002 160 0 167 7 8 8 (outt of 173) Illiteracyy (% of people > 15 year) 65% % 63% % 1% % Numberr of universities 1 1 0 0 13 3 Telephoness per 1000 inhabitants 23 3 7 7 607 7 Mainn religions: Muslim m 95% % 38% % 4% % Christian n 4% % 8% % 52% % Animist t — — 54% % -- Infantt mortality ratio (per 1000 live births) 78 8 110 0 4 4 Maternall mortality ratio (per 100,000 live 1100 0 910 910 7 7 births) ) Lifee expectancy in years (women) 49 9 47 7 81 1 Lifee expectancy in years (men) 45 5 44 4 75 5 Vaccinationn coverage** 90% % 6% % 95% % Prevalencee of HIV-1 in general adult 1.0% % 4.4% % 0.2% % population n Prevalencee of HIV-2 in general adult 0.8% % 3.9% % -- population n ** Minus indicates aid is given, not received. ** % of children fully immunised with 6 vaccines beforee age 1 year. GNP = Gross National Product; p.a. = per annum; PPP = Purchasing powerr parity; UNDP = United Nations Development Program. Sources:: Wolters-Noordhoff. De Grote Bosatlas. 52nd Ed. Groningen, Wolters-Noordhoff Atlasprodukties;; 2002. UNAIDS. Report on the Global HIV/AIDS Epidemic 2002. Geneva: UNAIDS;; 2002. Norrgren H, Da Silva ZJ, Biague AJ, Andersson S, Biberfeld G. Trends of HIV-11 and HIV-2 in Guinea-Bissau before and after the civil war 1998-9. XII International Conferencee on AIDS and STDs in Africa. Ouagadougou, December 2001 [Abstract 11DT5- 5].. UNDP. Human Development Report 2002. New York: OUP; 2002. firstfirst round of the sentinel surveillance among antenatal attendees was conducted in 2000- 11 and the prevalence was compared to the prevalence found during tJhe Gambian Mother-to-Childd HIV Transmission study of 1993-5 [19]. Thee first cohort reported here is located in Guinea-Bissau. In 1988 Dr Dominique Ricard,, while working in clinics for commercial sex workers in Ziguinchor (Senegal), noticedd that a disproportionate number of the women who were HIV-2 infected came 14 4 HIV-22 IN WEST AFRICA West t Africa a Thee Gambia Guinea a fromm Guinea-Bissau, and that most of those came from one particular rural area in north- westernn Guinea-Bissau.
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