An epidemic of hepatitis C virus infection while treating endemic infectious diseases in Equatorial Africa more than a half century ago: did it also jump-start the AIDS pandemic?
An epidemic of hepatitis C virus infection while treating endemic infectious diseases in Equatorial Africa more than a half century ago: did it also jump-start the AIDS pandemic?
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半个多世纪前，赤道非洲在治疗地方性传染病时丙型肝炎病毒感染流行：它是否也引发了艾滋病的流行？
DOI：
10.1086/656234
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发表时间：
2010
期刊：
影响因子：
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通讯作者：
Strickland,GThomas
中科院分区：
文献类型：
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作者：
Strickland,GThomas
Pépin等人[1，2]在本期《临床传染病》中发表的两篇文章报道了静脉和肌肉注射预防和治疗地方性传染病如何导致赤道非洲丙型肝炎病毒（HCV）和人类T淋巴细胞病毒（HTLV）-1感染。在中非共和国东南部的农村地区（锥虫病发病率很高）[2]和喀麦隆南部（疟疾和其他地方性传染病广泛使用肠胃外治疗）[1]，都靠近SIV cpz的地点，SIV cpz被认为是人类免疫缺陷病毒（HIV）-1的前体，已从黑猩猩中分离出来[3，4]。因此，他们推测，这些医源性暴露可能是从少数接触“丛林肉”的感染者的孤立病例中启动了艾滋病毒大流行。这明显增加了感染的水库，并导致持续的人与人之间的艾滋病毒性传播。研究的人群是老年当地居民。中非共和国研究的结论是，1951年之前的大规模锥虫治疗导致HCV基因型4的医源性传播，1947-1953年人群广泛使用肌内喷他脒化学预防锥虫可能传播了HTLV-1。他们的数据显示，1951年以前接受治疗的锥虫病患者死亡率明显过高，这表明SIV cpz/HIV-1也可能是医源性传播的[2]。
Two articles in this issue of Clinical Infectious Diseases by Pépin et al [1, 2] report how intravenous and intramuscular prophylaxis and treatment of endemic infectious diseases led to hepatitis C virus (HCV) and human T lymphotropic virus (HTLV)—1 infection in Equatorial Africa. Both of the rural areas, in southeast Central Africa Republic (where there was a high incidence of trypanosomiasis)[2] and in southern Cameroon (where there was extensive use of parenteral therapy for malaria and other endemic infectious diseases)[1], are near sites where SIV cpz, believed to be the precursor of human immunodeficiency virus (HIV)-1, has been isolated from chimpanzees [3, 4]. Thus, they hypothesize that these iatrogenic exposures may have jump-started the HIV pandemic from a few isolated cases of infected persons exposed to “bush meat.” This markedly increased the reservoir of infection and led to sustained human-tohuman sexual transmission of HIV.The populations studied were elderly local inhabitants. The conclusion in the Central Africa Republic study was that mass trypanosomiasis therapy before 1951 caused iatrogenic transmission of HCV genotype 4 and that population-wide use of intramuscular pentamidine chemoprophylaxis for trypanosomiasis in 1947–1953 may have transmitted HTLV-1. Their data showing markedly excessive mortality among patients with trypanosomiasis treated before 1951 suggest that SIV cpz/HIV-1 could have also been iatrogenically transmitted [2].