Clinical experience of AIDS in relation to HIV-1 and HIV-2 infection in a rural hospital in Ivory Coast, West Africa

Abstract

A dramatic rise in AIDS cases in a rural hospital 60 km west of Abidjan is described. Out of 212 adult cases diagnosed between January and November 1987 as having AIDS, using the World Health Organization (WHO) criteria defined in Bangui, 128 (60%) had antibodies to HIV-1 only, 61 (29%) had antibodies to both HIV-1 and HIV-2, 15 (7%) had antibodies to HIV-2 only and eight (4%) had no detectable antibodies to HIVs. These results, taken together with those of Ouattara et al. showing that both retroviruses have a similar seroprevalence in the general rural and urban populations, suggest that HIV-2 may have a lower physiopathological potential than HIV-1. This suggestion is supported by a 6-month follow-up of 60 AIDS cases, but only longer follow-up of cohorts of patients and healthy subjects with antibodies to one of the two viruses will allow definitive conclusions.

PIP: 212 adults with symptomatology indicative of acquired immunodeficiency syndrome (AIDS) presented to the Ivory Coast's Dabou Hospital between January-November 1987. 163 were males and 49 were females; the majority (151) were from rural areas. In terms of the clinical profile, 99% had experienced severe weight loss (greater than 10% of body weight), 43% had generalized pruritus, 66% reported fever exceeding 1 month's duration, 75% reported diarrhea exceeding 1 month's duration, 55% had experienced coughing for longer than 1 month, and 56% demonstrated generalized adenopathies. 128 (60%) of these 212 individuals were positive for antibodies to human immunodeficiency virus (HIV)-1, 15 (7%) were HIV-2 positive, 61 (29%) were seropositive for both HIV-1 and HIV-2, and 8 (4%) were negative for both viruses. Clinical follow-up was possible in 173 of these cases. After 6 months, those infected with HIV-1 manifested 16 unfavorable outcomes (deterioration or death) and 11 favorable outcomes (stable or improved condition). Among those infected with HIV-2, there were no unfavorable and 4 favorable cases. The group positive for HIV-1 and HIV-2 exhibited a clinical course at 6 months similar to that found among the HIV-1 seropositives: 11 unfavorable and 9 favorable outcomes. The data from the Dabou hospital attest to a steady rise in AIDS detection, from 0.21% of all adult outpatient cases in the 1st quarter of 1987 to 1.03% of cases in the last quarter. Although data from this series suggest a milder evolution for HIV-2 associated cases, a clinical follow-up of individuals seropositive for HIV-1 or HIV-2, over a 2-year period, is underway to confirm whether there is indeed a distinct symptomatology and disease pattern for each viral infection.