Epidemic history and iatrogenic transmission of blood-borne viruses in mid-20th century Kinshasa

Hogan C, Iles J, Frost EH, Giroux G, Cassar O, Gessain A, Dion M-J, Ilunga V, Rambaut A, Yengo-ki-Ngimbi A-E, Behets F, Pybus OG & PĂ©pin J

(2016) The Journal of Infectious Diseases 214, 353-360.

BACKGROUND: ?The HIV-1 pandemic was ignited in LĂ©opoldville (Kinshasa), Belgian Congo. Factors that jumpstarted its early expansion remain unclear. Non-lethal Hepatitis C and human T-cell lymphotropic viruses can be used to investigate past iatrogenic transmission. METHODS: ?We undertook a cross-sectional study of elderly inhabitants of Kinshasa, with serological assays, amplification and sequencing. Risk factors were assessed through logistic regression. Phylogenetic methods reconstructed the genetic history of HCV. RESULTS: ?217/839 (25.9%) participants were HCV-seropositive; 26 (3.1%) were HTLV-1-seropositive. Amplification products were obtained from 118 HCV-seropositives; subtypes 4k (n=47) and 4r (n=38) were most common. Independent risk factors for HCV subtype 4r were intramuscular tuberculosis therapy, intravenous injections at Hospital A, intravenous injections before 1960 and injections at a colonial-era venereology clinic. Intravenous injections at Hospital B and antimalarials were associated with HCV subtype 4k. Risk factors for HTLV-1 included intravenous injections at Hospitals C or D, and transfusions. Evolutionary analysis of viral sequences revealed independent exponential amplification of HCV subtypes 4r and 4k from the 1950s onwards. CONCLUSIONS: ?Iatrogenic transmission of HCV and HTLV-1 occurred in mid-20(th) century Kinshasa, at the same time and place HIV-1 emerged. Iatrogenic routes may have contributed to the early establishment of the pandemic.

Andrew Rambaut, 2007