An epidemic of hepatitis C virus infection while treating endemic infectious diseases in Equatorial Africa more than a half century ago: did it also jump-start the AIDS pandemic?

Two articles in this issue of Clinical Infectious Diseases by Pépin et al [1, 2] report how intravenous and intramuscular prophylaxis and treatment of endemic infectious diseases led to hepatitis C virus (HCV) and human T lymphotropic virus (HTLV)–1 infection in Equatorial Africa. Both of the rural areas, in southeast Central Africa Republic (where there was a high incidence of trypanosomiasis) [2] and in southern Cameroon (where there was extensive use of parenteral therapy for malaria and other endemic infectious diseases) [1], are near sites where SIVcpz, believed to be the precursor of human immunodeficiency virus (HIV)–1, has been isolated from chimpanzees [3, 4]. Thus, they hypothesize that these iatrogenic exposures may have jump-started the HIV pandemic from a few isolated cases of infected persons exposed to “bush meat.”