IJE Advance Access originally published online on March 16, 2006
International Journal of Epidemiology 2006 35(5):1322-1328; doi:10.1093/ije/dyl037
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Sixteen years of HIV surveillance in a West African research clinic reveals divergent epidemic trends of HIV-1 and HIV-2
MRC Laboratories, PO Box 273, Banjul, The Gambia
* Corresponding author. International Antiviral Therapy Evaluation Centre, Pietersbergweg 9, 1105 BM Amsterdam, The Netherlands. E-mail: m.schim{at}iatec.com
Background The HIV-1 epidemic in West Africa is characterized by a slower rise than that in Eastern and Southern Africa. The HIV-2 epidemic in West Africa may be declining, but few long-term data exist.
Methods In a research clinic in The Gambia, HIV-1 and HIV-2 prevalence trends among all new patients being tested for HIV were examined over a 16 year period (1988 till 2003). In newly diagnosed patients a baseline CD4 count was done.
Results An HIV test was done in 23 363 patients aged 15 years or older. The prevalence of HIV-1 was 4.2% in 1988–91 and rose to 17.5% in 2001–03 (P < 0.0001, 
2-test for trend). The prevalence of HIV-2 was 7.0% in 1988–91 and declined to 4.0% in 2001–03 (P < 0.0001). HIV-1 prevalence increased and HIV-2 prevalence decreased with time in logistic regression models adjusting for age, sex, and indication for test (P < 0.0001). Baseline CD4 counts were available for 65% of patients. The median CD4 count was 215 cells/mm3 [interquartile range (IQR) 72–424] for HIV-1, and 274 (IQR 100–549) for HIV-2 infected patients. There was no marked trend of rise or decline in baseline CD4 count in either HIV-1 or HIV-2 infected patients over the study period. Forty-five per cent of newly diagnosed HIV patients had a CD4 count <200 cells/mm3.
Conclusions These data suggest that HIV-1 prevalence is rising in The Gambia, and that HIV-2 is declining. HIV patients in The Gambia present late and almost half of patients would qualify for anti-retroviral treatment at their first visit.
Keywords HIV-1, HIV-2, Africa, The Gambia, prevalence, CD4 lymphocyte count
Accepted 10 February 2006
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