HTLV-1 INFECTION IN A POPULATION-BASED COHORT OF OLDER PERSONS IN GUINEA-BISSAU, WEST-AFRICA - RISK-FACTORS AND IMPACT ON SURVIVAL

In 1989, a population-based cohort of persons aged greater than or equ al to 50 years was established in an urban area of Guinea-Bissau, West Africa. Overall, 346 persons were interviewed in detail about risk be haviors and had capillary blood drawn. Among women, 12.4% were HTLV-1 seropositive, compared with 4.6% in men. No HTLV-2 was found. Seroposi tivity varied considerably according to place of birth and ethnic grou p. In women, but not in men, HTLV-1 seropositivity was strongly associ ated with early sexual debut (10-14 yrs, 33.3%; 15-17 yrs, 26.0%; 18-2 0 yrs, 6.5%; 21+ yrs, 0%; p(trend) = 0.001), lifetime number of male p artners (p(trend) = 0.006), and the male partner's number of co-wives (p(trend) = 0.006). There was also a 3.1-fold increased risk of being HTLV-1 seropositive if the woman was also HIV-2 seropositive. In a mul tivariate-risk-factor analysis, the strongest association with HTLV-1 was a history of having been bitten by a monkey (n = 11; combined ORad justed = 10.1; 95% CI 2.3-44.4), Ornamental scarification was associat ed with a 3.3-fold increased risk. Ethnic affiliation also significant ly influenced the risk of being HTLV-1 seropositive, Follow-up perform ed in January 1996 revealed no difference in survival between HTLV-1-s eropositive and -seronegative individuals over 6 years (rate ratio = 1 .4, 95% CI 0.7-2.8). In conclusion, this population, which has very hi gh HIV-2 seroprevalence, is also highly endemic for HTLV-1. Whereas se xual behaviors are clearly important for HTLV-1 spread in women, non-s exual risk factors were the only ones of potential importance in men. HTLV-1 had no impact on survival in this older population. (C) 1998 Wi ley-Liss, Inc.