High GUD incidence in the early 20th century created a particularly permissive time window for the origin and initial spread of epidemic HIV strains

Joã;o Dinis de Sousa, V. Müller, Philippe Lemey, Anne Mieke Vandamme

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

The processes that permitted a few SIV strains to emerge epidemically as HIV groups remain elusive. Paradigmatic theories propose factors that may have facilitated adaptation to the human host (e.g., unsafe injections), none of which provide a coherent explanation for the timing, geographical origin, and scarcity of epidemic HIV strains. Our updated molecular clock analyses established relatively narrow time intervals (roughly 1880-1940) for major SIV transfers to humans. Factors that could favor HIV emergence in this time frame may have been genital ulcer disease (GUD), resulting in high HIV-1 transmissibility (4-43%), largely exceeding parenteral transmissibility; lack of male circumcision increasing male HIV infection risk; and gender-skewed city growth increasing sexual promiscuity. We surveyed colonial medical literature reporting incidences of GUD for the relevant regions, concentrating on cities, suffering less reporting biases than rural areas. Coinciding in time with the origin of the major HIV groups, colonial cities showed intense GUD outbreaks with incidences 1.5-2.5 orders of magnitude higher than in mid 20th century. We surveyed ethnographic literature, and concluded that male circumcision frequencies were lower in early 20th century than nowadays, with low rates correlating spatially with the emergence of HIV groups. We developed computer simulations to model the early spread of HIV-1 group M in Kinshasa before, during and after the estimated origin of the virus, using parameters derived from the colonial literature. These confirmed that the early 20th century was particularly permissive for the emergence of HIV by heterosexual transmission. The strongest potential facilitating factor was high GUD levels. Remarkably, the direct effects of city population size and circumcision frequency seemed relatively small. Our results suggest that intense GUD in promiscuous urban communities was the main factor driving HIV emergence. Low circumcision rates may have played a role, probably by their indirect effects on GUD.

Original languageEnglish
Article numbere9936
JournalPLoS One
Volume5
Issue number4
DOIs
Publication statusPublished - 2010

Fingerprint

disease incidence
genitalia
Ulcer
HIV
Incidence
Male Circumcision
Human immunodeficiency virus 1
HIV-1
incidence
Literature
HIV infections
concentrating
Viruses
computer simulation
rural areas
Heterosexuality
Population Density
Clocks
Computer Simulation
population size

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

High GUD incidence in the early 20th century created a particularly permissive time window for the origin and initial spread of epidemic HIV strains. / de Sousa, Joã;o Dinis; Müller, V.; Lemey, Philippe; Vandamme, Anne Mieke.

In: PLoS One, Vol. 5, No. 4, e9936, 2010.

Research output: Contribution to journalArticle

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