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Rwanda: cases and investigations

Many studies from Rwanda have reported unexplained HIV infections in men and women with no identified sexual risk and in children with HIV-negative mothers. But government has not responded by investigating any of these reports. The list below is ordered by year, and may well be incomplete.

1984-86: Unexpected HIV infections in children: During 1984-86, doctors at the Kigali Central Hospital tested the mothers of 76 HIV-positive children aged 1-48 months. Eighteen (24%) of 76 mothers were HIV-negative. The 18 children with HIV-negative mothers had received an average of 1.8 injections per month, 7 had been transfused, and 8 had previously been hospitalized. Three mothers who first tested HIV-negative later tested HIV-positive; these mothers might have been infected by their children through breastfeeding (many children infected during hospital-based HIV outbreaks in Russia, Libya, Kazakhstan and elsewhere have transmitted HIV to their mothers, presumably through breastfeeding).[1]

1989: Unexpected HIV in women: A study among couples in Kigali in 1988 found 25 HIV-positive women with HIV-negative husbands. Fifteen of the 25 women reported that their HIV-negative husband was their only lifetime sex partner.[paragraph 1, page 1609 in reference 2]

1991-93: Unexpected HIV in children: In 1991-93, WHO’s Global Programme on AIDS arranged for hospitals to test children aged 6-59 months (1/2 to 5 years old) admitted to pediatric care and their mothers in 4 cities in Africa: Kigali, Rwanda; Dar es Salaam, Tanzania; Kampala, Uganda; and Lusaka, Zambia. The studies tested 5,593 child-mother pairs, of which 61 (1.1% of 5,593) children were HIV-positive with HIV-negative mothers. The reports on this study do not give any breakdown by country. The authors conclude (incredibly!): “The risk of nosocomial and non-perinatally acquired HIV infection appears low among these populations.” This shows a double-standard for Africa; if 1% of inpatient Europeans had unexpected HIV infections, such a conclusion would be unacceptable.[3]

2013-14: Unexplained new HIV infections in 3 villages: During 2013-14, Rwanda’s Ministry of Health with the Global Fund, WHO, and UNAIDS tested and then re-tested more than 10,000 randomly selected HIV-negative adults to measure HIV incidence (new infections). The surveys tested adults from 14 randomly selected households in 492 randomly selected villages. The surveys found three villages with multiple new and unexplained HIV infections. The study team recognized a problem: “the estimated probability of observing two or more villages with three or more households [out of the 14 sampled] with incident infections was 0.0001. Thus, these multiple cases within villages and households, which accounted for nine infections, suggest that HIV outbreaks had a role in the spread of HIV in Rwanda.”[page e 462 in reference 4]

References

1. Lepage P, Van de Perre P, Carael M, Butzler JP: Are medical infections a risk factor for HIV infection in children? Lancet 1986; ii: 1103-1104. Lepage P, Van de Perre P. Nosocomial transmission of HIV in Africa: what tribute is paid to contaminated transfusions and medical injections. Infect Control Hosp Epidemiol 1988; 9: 200-203.

2. Allen S, Tice J, Van de Perre P, et al: Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. BMJ 1992, 304: 1605-1609. Available at: http://www.bmj.com/highwire/filestream/331614/field_highwire_article_pdf/0.pdf (accessed 5 January 2012).

3. Hitimana D, Luo-Mutti C, Madraa B, et al. A multicentre matched case control study of possible nosocomial HIV-1 transmission in infants and children in developing countries. 9th Int Conf AIDS, Berlin 6-11 June 1993. Abstract no. WS-C13-2. Available at: http://ww1.aegis.org/aidsline/1993/nov/M93B3075.html (accessed 31 August 2012).

4. Nsanzimana S, Remera E, Kanters S, et al. Household survey of HIV incidence in Rwanda: a national observational cohort study. Lancet HIV 2017: 4: e457-e464. Available at: http://www.thelancet.com/pdfs/journals/lanhiv/PIIS2352-3018(17)30124-8.pdf (accessed 13 February 2018).

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