Increased prevalence of HIV-2 infection in hospitalized patients with severe bacterial diseases in Guinea-Bissau

We studied the association between HIV-2 infection and bacterial pneumonia, sepsis or pyomyositis, as well as the influence of HIV-2 infection on the clinical outcome in patients with these bacterial infections. A total of 201 consecutive hospitalized patients were included at the Simao Mendes National Hospital in Bissau, Guinea-Bissau. Age- and sex-matched controls were selected from an ongoing census in a semi-urban area of Bissau. Among 201 cases with such bacterial infection the prevalence of HIV-1 was 5.4%, HIV-2, 27.9%, and both HIV-1 and HIV-2 reactivity 6.4%. Among controls, the corresponding prevalence rates were significantly lower, 1.5%, 9.0% and 1.0%, respectively. A total of 140, 31 and 30 cases of pneumonia, sepsis and pyomyositis were included, and the differences in prevalence of HIV-2 compared with the controls also remained significant for each diagnosis separately. Lymphocyte subsets were determined in 93 consecutive patients, and the CD4 cell counts and CD4/CD8 lymphocyte ratios were markedly suppressed in the HIV-2-seropositive group. Due to excess mortality in the seropositive groups with sepsis (75.0%) and pyomyositis (25.0%), the mortality during hospitalization was significantly higher among HIV-2 infected compared to HIV-negative patients. Among cases of pneumonia the mortality was low in the HIV-2-seropositive (2.9%) as well as in the HIV-seronegative (3.4%) group.The association between HIV-2 infection and bacterial pneumonia, sepsis, and pyomyositis was examined in 201 consecutive patients hospitalized at Simao Mendes National Hospital in Bissau, Guinea-Bissau with such bacterial diseases and 201 age- and sex-matched controls drawn from a census in a semi-urban area of Bissau. Among cases, HIV-1 prevalence was 5.4%, HIV-2 prevalence was 27.9%, and combined HIV-1 and HIV-2 prevalence was 6.4%. Among controls, these prevalences were 1.5%, 9.0%, and 1.0%, respectively. The prevalence of HIV-2 infection was 25.0% among cases with pneumonia (n = 140), 38.7% among those with sepsis (n = 31), and 30.0% among those with pyomyositis (n = 30). Among the 93 cases for whom T lymphocytes were determined, the absolute number and percentage of CD4 cells and the CD4/CD8 cell ratios were markedly suppressed in the HIV-2-positive group, especially in those with sepsis. Of the 194 patients available for follow-up, 160 were classified as cured or improved, 10 did not improve, and 24 died. Mortality from sepsis and pyomyositis was significantly greater among HIV-2-infected cases than HIV-negative patients. The median percentage of CD4 cells was significantly lower among HIV-2-positive patients who died (9.0%) than survivors (16.5%). These findings confirm the existence of a significant association between HIV-2 and severe bacterial infections as well as a significantly higher mortality during hospitalization from sepsis and pyomyositis in HIV-2-positive patients compared to HIV-negative patients.