High GUD Incidence in the Early 20th Century Created a Particularly Permissive Time Window for the Origin and Initial Spread of Epidemic HIV Strains
High GUD Incidence in the Early 20th Century Created a Particularly Permissive Time Window for the Origin and Initial Spread of Epidemic HIV Strains
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DOI：
10.1371/journal.pone.0009936
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发表时间：
2010-04-01
期刊：
影响因子：
3.7
通讯作者：
Vandamme, Anne-Mieke
中科院分区：
文献类型：
--
作者：
de Sousa, Joao Dinis;Mueller, Viktor;Vandamme, Anne-Mieke
一些SIV病毒株作为HIV病毒群迅速出现的过程仍然难以捉摸。范式理论提出了可能促进适应人类宿主的因素（例如，不安全注射），其中没有一个提供一个连贯的解释的时间，地理来源，和稀缺的流行性艾滋病毒菌株。我们最新的分子钟分析建立了相对较窄的时间间隔（大约1880-1940），主要的SIV转移到人类。在这一时间范围内可能有利于艾滋病毒出现的因素可能是生殖器溃疡病（GUD），导致高HIV-1传播率（4-43%），大大超过肠胃外传播率;缺乏男性包皮环切术增加男性艾滋病毒感染风险;以及性别倾斜的城市增长增加性滥交。我们调查了殖民地医学文献报告发病率的GUD的相关地区，集中在城市，遭受较少的报告偏见比农村地区。与主要HIV群体的起源时间一致，殖民地城市显示出强烈的GUD爆发，发病率比世纪中期高1.5-2.5个数量级。我们调查了人种学文献，并得出结论，男性包皮环切术的频率在20（th）世纪早期比现在低，与艾滋病毒群体的出现空间相关的低利率。我们开发了计算机模拟模型的早期传播的HIV-1 M组在金沙萨之前，期间和之后的估计起源的病毒，使用参数来自殖民文献。这些研究证实，世纪早期对艾滋病毒通过异性性传播的出现特别宽容。最强的潜在促进因素是高GUD水平。值得注意的是，城市人口规模和割礼频率的直接影响似乎相对较小。我们的研究结果表明，在滥交的城市社区中，强烈的GUD是推动艾滋病毒出现的主要因素。低包皮环切率可能发挥了作用，可能是通过其对GUD的间接影响。
The processes that permitted a few SIV strains to emerge epidemically as HIV groups remain elusive. Paradigmatic theories propose factors that may have facilitated adaptation to the human host (e.g., unsafe injections), none of which provide a coherent explanation for the timing, geographical origin, and scarcity of epidemic HIV strains. Our updated molecular clock analyses established relatively narrow time intervals (roughly 1880-1940) for major SIV transfers to humans. Factors that could favor HIV emergence in this time frame may have been genital ulcer disease (GUD), resulting in high HIV-1 transmissibility (4-43%), largely exceeding parenteral transmissibility; lack of male circumcision increasing male HIV infection risk; and gender-skewed city growth increasing sexual promiscuity. We surveyed colonial medical literature reporting incidences of GUD for the relevant regions, concentrating on cities, suffering less reporting biases than rural areas. Coinciding in time with the origin of the major HIV groups, colonial cities showed intense GUD outbreaks with incidences 1.5-2.5 orders of magnitude higher than in mid 20 th century. We surveyed ethnographic literature, and concluded that male circumcision frequencies were lower in early 20(th) century than nowadays, with low rates correlating spatially with the emergence of HIV groups. We developed computer simulations to model the early spread of HIV-1 group M in Kinshasa before, during and after the estimated origin of the virus, using parameters derived from the colonial literature. These confirmed that the early 20(th) century was particularly permissive for the emergence of HIV by heterosexual transmission. The strongest potential facilitating factor was high GUD levels. Remarkably, the direct effects of city population size and circumcision frequency seemed relatively small. Our results suggest that intense GUD in promiscuous urban communities was the main factor driving HIV emergence. Low circumcision rates may have played a role, probably by their indirect effects on GUD.