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Trans R Soc Trop Med Hyg. 1990 Jan-Feb;84(1):144-7.

HIV, HBV, delta-agent and Treponema pallidum infections in two rural African areas.

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Department of Infectious Diseases, S. Anna Hospital, Como, Italy.


In order to compare the seroepidemiology of human immunodeficiency virus (HIV), hepatitis B virus, delta agent and Treponema pallidum infections in two rural populations living in north Uganda (Kitgum district) and in central Burundi (Butezi, Ruyigi region), 448 sera were tested for HBS-Ag, HBS-Ab, and anti-HIV antibodies and screened for syphilis using the T. pallidum haemagglutination (TPHA) test. HBS-Ag positive sera were also tested for anti-delta antibodies. Overall seropositivity rates in healthy subjects, outpatients and inpatients (non-AIDS) were 14.2% and 9.5% in Kitgum district and Butezi, respectively. The prevalence of HBS-Ag and HBS-Ab ranged from 10.0% to 15.6% and from 66.2% to 68.9%, respectively. In north Uganda the rates of anti-delta positivity were 3.1% in the overall population and 30.6% in the HBS-Ag positive subjects. No serum obtained in Butezi was anti-delta positive. In Ugandan people, 64.0% of anti-HIV positive and 25.8% of anti-HIV negative patients were also TPHA-positive (P less than 0.01). For Butezi the corresponding figures were 21.4% and 1.6% respectively (P less than 0.04). On the contrary, no correlation was found between either anti-HIV or TPHA positives and seropositivity for B and delta hepatitis serological markers. The study demonstrated an association between seropositivities for HIV and T. pallidum (TPHA), suggesting common patterns of transmission. On the contrary, no association seemed to exist between HBV and HIV infections.


In 1986, health workers collected 358 serum samples from 134 people living in rural Kitgum district in north Uganda and, in 1987, 90 serum samples from 30 healthy people in the Butezi and Ruyigi regions of central Burundi to compare the seroepidemiology of HIV, hepatitis B virus (HBV), delta agent hepatitis, and Treponema pallidum infections. Laboratory staff used ELISA to test for HIV and confirmed all positive samples with the Western blot test. The radioimmunoassay (RIA) test was used for HBV infection and for delta agent hepatitis infection. T. pallidum hemagglutination (TPHA) test was used to check for past syphilis infection. 10% of the people in Kitgum district tested positive for HBV surface antigens (HBS-Ag) and 66.2% for HBV antibodies (HBS-Ab) compared to 15.6% and 68.9% for those in Butezi. Further 3.1% of all people tested in northern Uganda tested positive for anti delta agent hepatitis. Moreover 30.6% of the people in northern Uganda who tested positive for HBS-Ag also tested positive for anti delta agent hepatitis. Yet no one in Butezi district who tested positive for anti delta agent hepatitis. In healthy patients, 14.2% of those in Kitgum district and 9.5% of those in Butezi district tested positive for HIV. In clinically suspected AIDS patients, these corresponding figures were 84.2% and 74.1%. 32.7% of the people in northern Uganda and 7.85 of those in Burundi tested positive for T. pallidum. Further 64% of all HIV positive cases also tested positive for TPHA compared to 25.8% of HIV negative cases (p.01). In Butezi, these figures were 21.4% and 1.6% (p.04). As for those with clinical features of AIDS and tested positive for HIV, 62.5% also tested positive for TPHA in Uganda and 25% in Burundi. In conclusion, HIV infection was strongly associated with previously preexisting patterns of sexually transmitted diseases, i.e., TPHA, but not with the HBV mode of transmission.

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