Mortality associated with HIV-1, HIV-2, and HTLV-1 single and dual infections in a middle-aged and older population in Guinea-Bissau

Background: In Guinea-Bissau HIV-1, HIV-2, and HTLV-1 are prevalent in the general population. The natural history of HIV/HTLV-1 single and dual infections has not been fully elucidated in this population. Previous studies have shown that combinations of these infections are more common in older women than in men. The present study compares mortality associated with HIV-1, HIV-2, and HTLV-1 single and dual infections in individuals over 35 years of age within an urban community-based cohort in Guinea-Bissau. Results: A total of 2,839 and 1,075 individuals were included in the HIV and HTLV-1 mortality analyses respectively. Compared with HIV-negative individuals, adjusted mortality rate ratios (MRRs) were 4.9 (95% confidence interval (CI): 2.3, 10.4) for HIV-1, 1.8 (95% CI: 1.5, 2.3) for HIV-2, and 5.9 (2.4, 14.3) for HIV-1/HIV-2 dual infections. MRR for HTLV-1-positive compared with HTLV-1-negative individuals was 1.7 (1.1, 2.7). Excluding all HIV-positive individuals from the analysis, the HTLV-I MRR was 2.3 (1.3, 3.8). The MRR of HTLV-1/HIV-2 dually infected individuals was 1.7 (0.7, 4.3), compared with HIV/HTLV-1-negative individuals. No statistically significant differences were found in retrovirus-associated mortality between men and women. Conclusion: HIV-1-associated excess mortality was low compared with community studies from other parts of Africa, presumably because this population was older and the introduction of HIV-1 into the community recent. HIV-2 and HTLV-1-associated mortality was 2-fold higher than the mortality in uninfected individuals. We found no significant differences between the mortality risk for HIV-2 and HTLV-1 single infection, respectively, and HIV-2/HTLV-1 dual infection. The higher prevalence of retroviral dual infections in older women is not explained by differential retrovirus-associated mortality for men and women.