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November 3, 1993, Vol 270, No. 17 >
ARTICLE | November 3, 1993

Epidemiology and Transmission of HIV-2: Title and subTitle BreakWhy There Is No HIV-2 Pandemic FREE

Kevin M. De Cock, MD, MRCP, DTM&H; Georgette Adjorlolo, MD; Ehounou Ekpini, MD; Toussaint Sibailly, MD; Justin Kouadio; Matthieu Maran; Kari Brattegaard; Kathleen M. Vetter, MPH; Ronan Doorly; Helene D. Gayle, MD, MPH
[+] Author Affiliations

Reprint requests to Department of Clinical Sciences, London School of Hygiene and Tropical Medicine, Keppel Street, London, England WC1E 7HT (Dr De Cock).


JAMA. 1993;270(17):2083-2086. doi:10.1001/jama.1993.03510170073033
Text Size: A A A
Published online
Article
References

Although human immunodeficiency virus type 1 (HIV-1) and HIV-2 share modes of transmission, their epidemiologic characteristics differ and international spread of HIV-2 has been very limited. Recently, the prevalence of infection with HIV-1 but not HIV-2 has increased rapidly in different West African countries, where HIV-2 was probably present earlier. Among 19 701 women of reproductive age tested in Abidjan, Ivory Coast, between 1988 and 1992, the prevalence of HIV-1 infection increased from 5.0% to 9.2%, while that of HIV-2 declined from 2.6% to 1.5%. Differences in viral load may be responsible: reported results of virus culture and polymerase chain reaction assays suggest that at high CD4+ T-lymphocyte counts viral load is lower in HIV-2—infected than in HIV-1—infected persons; the efficacy of heterosexual and perinatal transmission of HIV-2 is less efficient than that of HIV-1 at this stage. At low (<0.20×109/L [<200/μL]) CD4+ T-lymphocyte counts, virus isolation is equally successful for both viruses, and the efficacy of heterosexual transmission is similar. Differences in HIV-1 and HIV-2 natural history are reflected in differences in viral load, that for HIV-2 being lower until immunodeficiency is severe. Differences in viral load throughout most of the natural history of infection appear to correlate with lower transmissibility of HIV-2 than HIV-1 and are the likeliest explanation for their markedly different global epidemiology.

(JAMA. 1993;270:2083-2086)

REFERENCES

1 +
Piot P, Laga M, Ryder R, et al.  The global epidemiology of HIV infection: continuity, heterogeneity, and change. J Acquir Immune Defic Syndr . 1990;;3:403-412.
2 +
De Cock KM, Brun-Vezinet F.  Epidemiology of HIV-2. AIDS . 1989;;3( (suppl) ):S89-S95.
3 +
De Cock KM, Brun-Vezinet F, Soro B.  HIV-1 and HIV-2 infections and AIDS in West Africa. AIDS . 1991;;5( (suppl) ):S21-S28.
4 +
May MR, Anderson RM.  Transmission dynamics of HIV infection. Nature . 1987;;326:137-142.
5 +
Clavel F, Mansinho K, Chamaret S, et al.  Human immunodeficiency virus type 2 infection associated with AIDS in West Africa. N Engl J Med . 1987;; 316:1180-1185.
6 +
Maybey DCW, Tedder RS, Hughes ASB, et al.  Human retroviral infections in the Gambia: prevalence and clinical features. BMJ . 1988;;296:83-86.
7 +
De Cock KM, Odehouri K, Colebunders RL, et al.  A comparison of HIV-1 and HIV-2 infections in hospitalized patients in Abidjan, Côte d'Ivoire. AIDS . 1990;;4:443-448.
8 +
Le Guenno BM, Barabe P, Griffet PA, et al.  HIV-2 and HIV-1 AIDS cases in Senegal: clinical patterns and immunological perturbations. J Acquir Immune Defic Syndr . 1991;;4:421-427.
9 +
Naucler A, Albino P, Da Silva AP, et al.  HIV-2 infection in hospitalized patients in Bissau, Guinea Bissau. AIDS . 1991;;5:301-304.
10 +
De Cock KM, Gnaore E, Adjorlolo G, et al.  Risk of tuberculosis in patients with HIV-I and HIV-II infections in Abidjan, Ivory Coast. BMJ . 1991;;302: 496-499.
11 +
Siby T, Thior I, Marlink R, et al.  Natural history of HIV-2 vs HIV-1: clinical and immunological study in a cohort of female sex workers.  In: Program and abstracts of the Eighth International Conference on AIDS/Third STD World Congress ; July 19-24, 1992;; Amsterdam, the Netherlands. Abstract WeC 1066.
12 +
Lisse IM, Poulsen A-G, Aaby P, et al.  Immunodeficiency in HIV-2 infection: a community study from Guinea-Bissau. AIDS . 1990;;4:1263-1266.
13 +
Pepin J, Morgan G, Dunn D, et al.  HIV-2-induced immunosuppression among asymptomatic West African prostitutes: evidence that HIV-2 is pathogenic, but less so than HIV-1. AIDS . 1991;;5: 1165-1172.
14 +
Kestens K, Brattegaard K, Adjorlolo G, et al.  Immunological comparison of HIV-1-, HIV-2- and dually-reactive women delivering in Abidjan, Côte d'Ivoire. AIDS . 1992;;6:803-807.
15 +
Egboga A, Corrah T, Todd A, et al.  Immunological findings in African patients with pulmonary tuberculosis and HIV-2 infection. AIDS . 1992;;6: 1045-1046.
16 +
Lucas S, Hounnou A, Diomande M, et al.  The pathology of terminal HIV-2 infection in Abidjan, Côte d'Ivoire.  In: Program and abstracts of the Sixth International Conference on AIDS in Africa ; December 16-19, 1991;; Dakar, Senegal. Abstract MO 102.
17 +
Simon F, Matheron S, Tamalet C, et al.  Cellular and plasma viral load in patients infected with HIV-2. AIDS . In press.
18 +
Loussert-Ajaka I, Simon F, Gamba E, et al.  Comparison between quantitative viremia and DNA detection by PCR in 16 HIV-2 patients.  In: Program and abstracts of the Seventh International Conference on AIDS in Africa ; December 8-11, 1992;; Yaoundé, Cameroon. Abstract TO026.
19 +
Loussert-Ajaka I, Simon F, Farfara I, et al.  HIV-2 DNA PCR: Evaluation of different sets of primers.  In: Program and abstracts of the Seventh International Conference on AIDS in Africa ; December 8-11, 1992;; Yaoundé, Cameroon. Abstract WPO63.
20 +
Rouzioux C, Puel J, Agut H, et al.  Comparative assessment of quantitative HIV viraemia assays. AIDS . 1992;;6:373-377.
21 +
Kawamura M, Yamazaki S, Ishikawa K, Kwofie TB, Tsujimoto H, Hayami M.  HIV-2 in West Africa in 1966. Lancet . 1989;;1:385.
22 +
Le Guenno B.  HIV1 and HIV2: two ancient viruses for a new disease? Trans R Soc Trop Med Hyg . 1989;;83:847.
23 +
Poulsen AG, Kvinesdal B, Aaby P, et al.  Prevalence of and mortality from human immunodeficiency virus type 2 in Bissau, West Africa. Lancet . 1989;;1:827-831.
24 +
O'Brien TR, George JR, Holmberg SD.  Human immunodeficiency virus type 2 infection in the United States: epidemiology, diagnosis, and public health implications. JAMA . 1992;;267:2775-2779.
25 +
Pfutzner A, Dietrich U, von Eichel U, et al.  HIV-1 and HIV-2 infections in a high-risk population in Bombay, India: evidence for the spread of HIV-2 and presence of a divergent HIV-1 subtype. J Acquir Immune Defic Syndr . 1992;;5:972-977.
26 +
Smallman-Raynor M, Cliff A.  The spread of human immunodeficiency virus type 2 into Europe: a geographical analysis. Int J Epidemiol . 1991;;20: 480-489.
27 +
Savarit D, De Cock KM, Schutz R, Konate S, Lackritz E, Bondurand A.  Risk of HIV infection from transfusion with blood negative for HIV antibody in a West African city. BMJ . 1992;;305:498-502.
28 +
Kanki P, M'Boup S, Marlink R, Guye A, Essex M.  Update on the epidemiology of HIV-2 in West Africa.  In: Program and abstracts of the Fifth International Conference on AIDS in Africa ; October 10-12, 1990;; Kinshasa, Zaire. Abstract WPB2.
29 +
Naucler A, Andersson S, Norrgren H, Dias F, Johansson I, Biberfeld G.  Prevalence and incidence of HIV-1, HIV-2, HTLV and Treponema pallidum infections among police officers in Guinea-Bissau.  In: Program and abstracts of the Eighth International Conference on AIDS in Africa ; December 8-11, 1992;; Yaoundé, Cameroon. Abstract WRT016.
30 +
Leisenring W, Donnely C, Sandberg S, Kanki P.  Decreased infectivity of HIV-2 compared to HIV-1: a mathematical model.  In: Program and abstracts of the Eighth International Conference on AIDS/ Third STD World Congress ; July 19-24, 1992;; Amsterdam, the Netherlands. Abstract WeC 1064.
31 +
Doorly R, Kadio A, Brattegaard K, et al.  Trends in HIV-1 and HIV-2 infections in Abidjan, Côte d'Ivoire, 1987-1990.  In: Program and abstracts of the Seventh International Conference on AIDS ; June 16-21, 1991;; Florence, Italy. Abstract MC 42.
32 +
Koffi K, Gershy-Damet G-M, Peeters M, Soro B, Rey J-L, Delaporte E.  Rapid spread of HIV infections in Abidjan, Ivory Coast, 1987-1990. Eur J Clin Microbiol Infect Dis . 1992;;11:1-2.
33 +
Kourouma K, Foucault-Fretz C, Diallo M-P, et al.  HIV-1 and HIV-2 seropositivity among AIDS cases in Guinea. AIDS . 1990;;4:1299-1300.
34 +
Sibailly TS, Adjorlolo G, Gayle H, et al.  Prospective study to compare HIV-1 and HIV-2 perinatal transmission in Abidjan, Côte d'Ivoire.  In: Program and abstracts of the Eighth International Conference on AIDS and Third STD World Congress ; July 19-24, 1992;; Amsterdam, the Netherlands. Abstract WeC 1065.
35 +
Gayle HD, Gnaore E, Adjorlolo G, et al.  HIV-1 and HIV-2 infection in children in Abidjan, Côte d'Ivoire. J Acquir Immune Defic Syndr . 1992;;5: 513-517.
36 +
De Cock KM, Porter A, Kouadio J, et al.  Rapid and specific diagnosis of HIV-1 and HIV-2 infections: an evaluation of testing strategies. AIDS . 1990;;4:875-878.
37 +
Kanki PJ.  West African human retroviruses related to STLV-III. AIDS . 1987;;1:141-145.
38 +
Pepin J, Dunn D, Gaye I, et al.  HIV-2 infection among prostitutes working in the Gambia: association with serological evidence of genital ulcer diseases and with generalized lymphadenopathy. AIDS . 1991;;5:69-75.
39 +
Wilkins A, Ricard D, Todd J, Whittle H, Dias F, Da Silva AP.  The epidemiology of HIV infection in a rural area of Guinea-Bissau. AIDS . 1993;;7: 1119-1122.
40 +
Allen S, Lindan C, Serufilira A, et al.  Human immunodeficiency virus infection in urban Rwanda: demographic and behavioral correlates in a representative sample of childbearing women. JAMA . 1991;;266:1657-1663.
41 +
Temmerman M, Ali FM, Ndinya-Achola J, Moses S, Plummer FA, Piot P.  Rapid increase of both HIV-1 infection and syphilis among pregnant women in Nairobi, Kenya. AIDS . 1992;;6:1181-1185.
42 +
Stuver SO, Tachibana N, Okayama A, et al.  Heterosexual transmission of human T cell leukemia/ lymphoma virus type I among married couples in southwestern Japan: an initial report from the Miyazaki Cohort Study. J Infect Dis . 1993;;167:57-65.
43 +
N'Gbichi J-M, Yeboue K, Ackah A-N, et al.  Comparison of heterosexual transmission of HIV-1 and HIV-2 infections in Abidjan, Côte d'Ivoire.  In: Program and abstracts of the Seventh International Conference on AIDS ; June 16-21, 1991;; Florence, Italy. Abstract MC 3025.
44 +
Lucas SB, Hounnou A, Peacock C, et al.  The mortality and pathology of HIV infection in a West African city. AIDS . In press.
45 +
Del Mistro A, Chotard J, Hall AJ, Whittle H, De Rossi A, Chieco-Bianchi L.  HIV-1 and HIV-2 seroprevalence rates in mother-child pairs living in the Gambia (West Africa). J Acquir Immune Defic Syndr . 1992;;5:19-24.
46 +
Poulsen A-G, Kvinesdal BB, Aaby P, et al.  Lack of evidence of vertical transmission of human immunodeficiency virus type 2 in a sample of the general population in Bissau. J Acquir Immune Defic Syndr . 1992;;5:25-30.
47 +
 Report of a Consensus Workshop, Sienna, Italy, January 17-18, 1992: factors involved in mother-to-child transmission of HIV. J Acquir Immune Defic Syndr . 1992;;5:1019-1029.
48 +
George JR, Ou C-Y, Parekh B, et al.  Prevalence of HIV-1 and HIV-2 mixed infections in Côte d'Ivoire. Lancet . 1992;;340:337-339.
49 +
Peeters M, Gershy-Damet G-M, Fransen K, et al.  Virological and polymerase chain reaction studies of HIV-1/HIV-2 dual infection in Côte d'Ivoire. Lancet . 1992;;340:339-340.
50 +
Traore-Ettiegne V, Ghijs PD, Diallo MO, et al.  High prevalence of HIV infection and other STD in female prostitutes in Abidjan.  In: Program and abstracts of the Ninth International Conference on AIDS ; June 6-11, 1993;; Berlin, Germany. Abstract WS-C08-3.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Piot P, Laga M, Ryder R, et al.  The global epidemiology of HIV infection: continuity, heterogeneity, and change. J Acquir Immune Defic Syndr . 1990;;3:403-412.
2 +
De Cock KM, Brun-Vezinet F.  Epidemiology of HIV-2. AIDS . 1989;;3( (suppl) ):S89-S95.
3 +
De Cock KM, Brun-Vezinet F, Soro B.  HIV-1 and HIV-2 infections and AIDS in West Africa. AIDS . 1991;;5( (suppl) ):S21-S28.
4 +
May MR, Anderson RM.  Transmission dynamics of HIV infection. Nature . 1987;;326:137-142.
5 +
Clavel F, Mansinho K, Chamaret S, et al.  Human immunodeficiency virus type 2 infection associated with AIDS in West Africa. N Engl J Med . 1987;; 316:1180-1185.
6 +
Maybey DCW, Tedder RS, Hughes ASB, et al.  Human retroviral infections in the Gambia: prevalence and clinical features. BMJ . 1988;;296:83-86.
7 +
De Cock KM, Odehouri K, Colebunders RL, et al.  A comparison of HIV-1 and HIV-2 infections in hospitalized patients in Abidjan, Côte d'Ivoire. AIDS . 1990;;4:443-448.
8 +
Le Guenno BM, Barabe P, Griffet PA, et al.  HIV-2 and HIV-1 AIDS cases in Senegal: clinical patterns and immunological perturbations. J Acquir Immune Defic Syndr . 1991;;4:421-427.
9 +
Naucler A, Albino P, Da Silva AP, et al.  HIV-2 infection in hospitalized patients in Bissau, Guinea Bissau. AIDS . 1991;;5:301-304.
10 +
De Cock KM, Gnaore E, Adjorlolo G, et al.  Risk of tuberculosis in patients with HIV-I and HIV-II infections in Abidjan, Ivory Coast. BMJ . 1991;;302: 496-499.
11 +
Siby T, Thior I, Marlink R, et al.  Natural history of HIV-2 vs HIV-1: clinical and immunological study in a cohort of female sex workers.  In: Program and abstracts of the Eighth International Conference on AIDS/Third STD World Congress ; July 19-24, 1992;; Amsterdam, the Netherlands. Abstract WeC 1066.
12 +
Lisse IM, Poulsen A-G, Aaby P, et al.  Immunodeficiency in HIV-2 infection: a community study from Guinea-Bissau. AIDS . 1990;;4:1263-1266.
13 +
Pepin J, Morgan G, Dunn D, et al.  HIV-2-induced immunosuppression among asymptomatic West African prostitutes: evidence that HIV-2 is pathogenic, but less so than HIV-1. AIDS . 1991;;5: 1165-1172.
14 +
Kestens K, Brattegaard K, Adjorlolo G, et al.  Immunological comparison of HIV-1-, HIV-2- and dually-reactive women delivering in Abidjan, Côte d'Ivoire. AIDS . 1992;;6:803-807.
15 +
Egboga A, Corrah T, Todd A, et al.  Immunological findings in African patients with pulmonary tuberculosis and HIV-2 infection. AIDS . 1992;;6: 1045-1046.
16 +
Lucas S, Hounnou A, Diomande M, et al.  The pathology of terminal HIV-2 infection in Abidjan, Côte d'Ivoire.  In: Program and abstracts of the Sixth International Conference on AIDS in Africa ; December 16-19, 1991;; Dakar, Senegal. Abstract MO 102.
17 +
Simon F, Matheron S, Tamalet C, et al.  Cellular and plasma viral load in patients infected with HIV-2. AIDS . In press.
18 +
Loussert-Ajaka I, Simon F, Gamba E, et al.  Comparison between quantitative viremia and DNA detection by PCR in 16 HIV-2 patients.  In: Program and abstracts of the Seventh International Conference on AIDS in Africa ; December 8-11, 1992;; Yaoundé, Cameroon. Abstract TO026.
19 +
Loussert-Ajaka I, Simon F, Farfara I, et al.  HIV-2 DNA PCR: Evaluation of different sets of primers.  In: Program and abstracts of the Seventh International Conference on AIDS in Africa ; December 8-11, 1992;; Yaoundé, Cameroon. Abstract WPO63.
20 +
Rouzioux C, Puel J, Agut H, et al.  Comparative assessment of quantitative HIV viraemia assays. AIDS . 1992;;6:373-377.
21 +
Kawamura M, Yamazaki S, Ishikawa K, Kwofie TB, Tsujimoto H, Hayami M.  HIV-2 in West Africa in 1966. Lancet . 1989;;1:385.
22 +
Le Guenno B.  HIV1 and HIV2: two ancient viruses for a new disease? Trans R Soc Trop Med Hyg . 1989;;83:847.
23 +
Poulsen AG, Kvinesdal B, Aaby P, et al.  Prevalence of and mortality from human immunodeficiency virus type 2 in Bissau, West Africa. Lancet . 1989;;1:827-831.
24 +
O'Brien TR, George JR, Holmberg SD.  Human immunodeficiency virus type 2 infection in the United States: epidemiology, diagnosis, and public health implications. JAMA . 1992;;267:2775-2779.
25 +
Pfutzner A, Dietrich U, von Eichel U, et al.  HIV-1 and HIV-2 infections in a high-risk population in Bombay, India: evidence for the spread of HIV-2 and presence of a divergent HIV-1 subtype. J Acquir Immune Defic Syndr . 1992;;5:972-977.
26 +
Smallman-Raynor M, Cliff A.  The spread of human immunodeficiency virus type 2 into Europe: a geographical analysis. Int J Epidemiol . 1991;;20: 480-489.
27 +
Savarit D, De Cock KM, Schutz R, Konate S, Lackritz E, Bondurand A.  Risk of HIV infection from transfusion with blood negative for HIV antibody in a West African city. BMJ . 1992;;305:498-502.
28 +
Kanki P, M'Boup S, Marlink R, Guye A, Essex M.  Update on the epidemiology of HIV-2 in West Africa.  In: Program and abstracts of the Fifth International Conference on AIDS in Africa ; October 10-12, 1990;; Kinshasa, Zaire. Abstract WPB2.
29 +
Naucler A, Andersson S, Norrgren H, Dias F, Johansson I, Biberfeld G.  Prevalence and incidence of HIV-1, HIV-2, HTLV and Treponema pallidum infections among police officers in Guinea-Bissau.  In: Program and abstracts of the Eighth International Conference on AIDS in Africa ; December 8-11, 1992;; Yaoundé, Cameroon. Abstract WRT016.
30 +
Leisenring W, Donnely C, Sandberg S, Kanki P.  Decreased infectivity of HIV-2 compared to HIV-1: a mathematical model.  In: Program and abstracts of the Eighth International Conference on AIDS/ Third STD World Congress ; July 19-24, 1992;; Amsterdam, the Netherlands. Abstract WeC 1064.
31 +
Doorly R, Kadio A, Brattegaard K, et al.  Trends in HIV-1 and HIV-2 infections in Abidjan, Côte d'Ivoire, 1987-1990.  In: Program and abstracts of the Seventh International Conference on AIDS ; June 16-21, 1991;; Florence, Italy. Abstract MC 42.
32 +
Koffi K, Gershy-Damet G-M, Peeters M, Soro B, Rey J-L, Delaporte E.  Rapid spread of HIV infections in Abidjan, Ivory Coast, 1987-1990. Eur J Clin Microbiol Infect Dis . 1992;;11:1-2.
33 +
Kourouma K, Foucault-Fretz C, Diallo M-P, et al.  HIV-1 and HIV-2 seropositivity among AIDS cases in Guinea. AIDS . 1990;;4:1299-1300.
34 +
Sibailly TS, Adjorlolo G, Gayle H, et al.  Prospective study to compare HIV-1 and HIV-2 perinatal transmission in Abidjan, Côte d'Ivoire.  In: Program and abstracts of the Eighth International Conference on AIDS and Third STD World Congress ; July 19-24, 1992;; Amsterdam, the Netherlands. Abstract WeC 1065.
35 +
Gayle HD, Gnaore E, Adjorlolo G, et al.  HIV-1 and HIV-2 infection in children in Abidjan, Côte d'Ivoire. J Acquir Immune Defic Syndr . 1992;;5: 513-517.
36 +
De Cock KM, Porter A, Kouadio J, et al.  Rapid and specific diagnosis of HIV-1 and HIV-2 infections: an evaluation of testing strategies. AIDS . 1990;;4:875-878.
37 +
Kanki PJ.  West African human retroviruses related to STLV-III. AIDS . 1987;;1:141-145.
38 +
Pepin J, Dunn D, Gaye I, et al.  HIV-2 infection among prostitutes working in the Gambia: association with serological evidence of genital ulcer diseases and with generalized lymphadenopathy. AIDS . 1991;;5:69-75.
39 +
Wilkins A, Ricard D, Todd J, Whittle H, Dias F, Da Silva AP.  The epidemiology of HIV infection in a rural area of Guinea-Bissau. AIDS . 1993;;7: 1119-1122.
40 +
Allen S, Lindan C, Serufilira A, et al.  Human immunodeficiency virus infection in urban Rwanda: demographic and behavioral correlates in a representative sample of childbearing women. JAMA . 1991;;266:1657-1663.
41 +
Temmerman M, Ali FM, Ndinya-Achola J, Moses S, Plummer FA, Piot P.  Rapid increase of both HIV-1 infection and syphilis among pregnant women in Nairobi, Kenya. AIDS . 1992;;6:1181-1185.
42 +
Stuver SO, Tachibana N, Okayama A, et al.  Heterosexual transmission of human T cell leukemia/ lymphoma virus type I among married couples in southwestern Japan: an initial report from the Miyazaki Cohort Study. J Infect Dis . 1993;;167:57-65.
43 +
N'Gbichi J-M, Yeboue K, Ackah A-N, et al.  Comparison of heterosexual transmission of HIV-1 and HIV-2 infections in Abidjan, Côte d'Ivoire.  In: Program and abstracts of the Seventh International Conference on AIDS ; June 16-21, 1991;; Florence, Italy. Abstract MC 3025.
44 +
Lucas SB, Hounnou A, Peacock C, et al.  The mortality and pathology of HIV infection in a West African city. AIDS . In press.
45 +
Del Mistro A, Chotard J, Hall AJ, Whittle H, De Rossi A, Chieco-Bianchi L.  HIV-1 and HIV-2 seroprevalence rates in mother-child pairs living in the Gambia (West Africa). J Acquir Immune Defic Syndr . 1992;;5:19-24.
46 +
Poulsen A-G, Kvinesdal BB, Aaby P, et al.  Lack of evidence of vertical transmission of human immunodeficiency virus type 2 in a sample of the general population in Bissau. J Acquir Immune Defic Syndr . 1992;;5:25-30.
47 +
 Report of a Consensus Workshop, Sienna, Italy, January 17-18, 1992: factors involved in mother-to-child transmission of HIV. J Acquir Immune Defic Syndr . 1992;;5:1019-1029.
48 +
George JR, Ou C-Y, Parekh B, et al.  Prevalence of HIV-1 and HIV-2 mixed infections in Côte d'Ivoire. Lancet . 1992;;340:337-339.
49 +
Peeters M, Gershy-Damet G-M, Fransen K, et al.  Virological and polymerase chain reaction studies of HIV-1/HIV-2 dual infection in Côte d'Ivoire. Lancet . 1992;;340:339-340.
50 +
Traore-Ettiegne V, Ghijs PD, Diallo MO, et al.  High prevalence of HIV infection and other STD in female prostitutes in Abidjan.  In: Program and abstracts of the Ninth International Conference on AIDS ; June 6-11, 1993;; Berlin, Germany. Abstract WS-C08-3.

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