Acquired immunodeficiency syndrome in a heterosexual population in Zaire

Human immunodeficiency virus type 2 infection associated with AIDS in West Africa

We recently reported the isolation of a new retrovirus, termed human immunodeficiency virus type 2 (HIV-2), from two West African patients with the acquired immunodeficiency syndrome (AIDS). This virus is related to but distinct from the well-characterized AIDS retrovirus, human immunodeficiency virus type 1 (HIV-1). We report here evidence of infection with HIV-2 in 30 patients, almost all from West Africa. Seventeen of them had a clinical syndrome indistinguishable from AIDS (7 of these 17 died). Others had either the AIDS-related complex or no HIV-related symptoms. All patients had serum antibodies reacting with HIV-2 in an indirect immunofluorescence assay. All serum tested contained antibodies reacting with the envelope glycoprotein of the virus in an immunoprecipitation assay. Cross-reactivity of serum antibodies with HIV-1 was detected in a minority of patients and varied according to the assay used. Retroviral isolates were obtained from the blood lymphocytes of 11 patients and were all identified as HIV-2 by nucleic acid hybridization; none hybridized with an HIV-1 probe. These findings indicate that some cases of AIDS in West Africa may be caused by HIV-2, but the extent of the spread of this virus and its clinical correlates will require careful epidemiologic investigation.

Genome organization and transactivation of the human immunodeficiency virus type 2

Analysis of the nucleotide sequence of the human retrovirus associated with AIDS in West Africa, HIV-2, shows that it is evolutionarily distant from the previously characterized HIV-1. We suggest that these viruses existed long before the current AIDS epidemics. Their biological properties are conserved in spite of limited sequence homology; this may help the determination of the structure-function relationships of the different viral elements.

Selective expansion of a CD3+CD4-CD8- subpopulation in clinical groups associated with human immunodeficiency virus infection

T lymphocytes (CD3+) without expression of CD4/CD8 surface antigens have recently been described in the thymus and peripheral lymphoid organs. We have conducted a retrospective analysis of the literature, seeking quantitative variations in this T-cell subset in normal heterosexual controls, and in risk, pre-AIDS, and AIDS groups, by means of the subtraction [CD3-(CD4+CD8]) and the ratio 100 X [CD3-(CD4+CD8])/CD3. Dramatic T lymphocytopaenia in AIDS patients and the progressive decay of CD4+ lymphocytes and increase of CD8+ lymphocytes throughout the clinical spectrum of HIV infection have been confirmed. Furthermore, we hereby demonstrate the selective expansion of CD3+CD4-CD8- lymphocytes, directly related to the clinical state in different clinical groups of infected people when compared with controls (P less than 0.05). The inverse relationship between the CD3+CD4-CD8- cell subset and other mature T-cell subsets, mainly CD4+ (r = -0.49; P less than 0.01), suggests the existence of mutual regulatory interactions. These in vivo results, which are in agreement with those obtained in long-term infected cultures, cannot be explained by direct cytopathic effects of the virus on the very few infected cells. Thus, the implication of the expansion of these functional precursors on the prognosis for infected people, and the paradoxes of the immunodeficiency, such as lymphoproliferation and autoimmune features, are discussed.

Acquired immunodeficiency syndrome after travelling in Africa: an epidemiological study in seventeen Caucasian patients

Seventeen Caucasian patients with acquired immunodeficiency syndrome (AIDS) contracted after long stays in Africa are reported. Central Africa was concerned in all cases. Men are particularly exposed to AIDS whatever their occupation. This study suggests that the risk of contracting AIDS in Africa is high; the transmission of the virus was related to sexual contact, particularly with prostitutes, in Africa in most of the cases. It suggests also that Caucasians who travel in Africa spread the virus throughout the world by means of their heterosexual relations.

Dermatologic findings and manifestations of acquired immunodeficiency syndrome (AIDS)

We present a review of the spectrum of human T-lymphotropic virus type III (HTLV-III) infection with particular emphasis on cutaneous manifestations in 217 patients. Correlations are made with immunodeficiency as measured by absolute T-helper cell number. A classification is presented of these dermatologic findings.

Evaluation of a clinical case-definition of acquired immunodeficiency syndrome in Africa

A provisional clinical case-definition for acquired immunodeficiency syndrome (AIDS) developed by the World Health Organisation (WHO) for use in Africa was tested on 174 inpatients at Mama Yemo Hospital, Kinshasa, Zaire. In this hospital population with a 34% infection rate of human immunodeficiency virus (HIV), the clinical case-definition had a specificity of 90%, a sensitivity of 59%, and a predictive value of 74% for HIV seropositivity. These results support the use of the WHO clinical definition for AIDS in Africa. However, since HIV prevalence and disease expression vary, similar evaluations should be carried out in different regions.

Prevalence of human T-lymphotropic retroviruses type III (HIV) and type IV in Ivory Coast

Serological investigations in the Ivory Coast indicate that, despite the rarity of overt acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV) is widely prevalent. So also is human T-lymphotropic virus type IV (HTLV-IV). The highest rates of HIV and HTLV-IV seropositivity were observed in female prostitutes. These findings suggest that, like HIV, HTLV-IV can be transmitted by heterosexual contact, and that the mobility of prostitutes may be an important factor in spread of the retroviruses in Africa. The incidence of HIV-associated AIDS in the Ivory Coast is likely to rise sharply in the next few years.

Lymphadenopathy-associated virus type 2 in AIDS and AIDS-related complex. Clinical and virological features in four patients

Lymphadenopathy-associated virus type 2 (HIV 2) was isolated from 3 patients with AIDS and 1 with AIDS-related complex. Clinical features were similar to those in patients infected with HIV 1. Viral isolates were characterised by hybridisation with HIV 1 and HIV 2 DNA probes. HIV 1 and HIV 2 serological studies were performed by enzyme-linked immunosorbent assay (ELISA), western blot, and radioimmunoprecipitation assay. HIV 2 IgG antibodies were detected in all sera. The molecular weights of the most representative HIV 2 proteins were determined by immunoblot. Cross-reactivity was restricted to HIV 1 and HIV 2 core proteins. In all 4 patients the neurotropism of HIV 2 was demonstrated by virus isolation from the cerebrospinal fluid and/or by evidence of intrathecal HIV 2 IgG synthesis. All sera were antibody negative by HIV 1 ELISA. An assay specific for HIV 2 is needed for screening of blood donations and for diagnosis and seroepidemiological study of HIV 2 infection.

Public awareness of AIDS in Rwanda

AIDS is a rapidly growing epidemic in Kigali, Rwanda. To understand the level of public awareness of AIDS in that city, 33 informants (15 men and 18 women) were interviewed during September, 1985. Most (66.7%) said that they first heard of the disease only within the previous eight months. About half (46.9%) could not mention one or more AIDS symptoms. Younger informants and women reported less knowledge of AIDS symptoms. While nearly everyone recognized AIDS as a stigmatized disease, most informants apparently did not know why it is stigmatized. Only about one-third of the informants (34.4%) could correctly state the mode of AIDS transmission. People who are at greatest risk for the disease, unmarried men and women, were least likely to know how it is transmitted. Half (50.0%) of those informants who responded to the question of the origins of AIDS said that it began in 'America.' While many informants are frightened by the disease, no one has yet changed their sexual behavior as a response to the epidemic. All informants agreed that more information about AIDS should be made available in Rwanda. Preventive measures against the spread of AIDS are urgently needed in central Africa.

A prevalence study of HIV antibodies in rural Kenya

In order to describe the prevalence of HIV antibodies and AIDS in West Kenya, serological tests, including ELISA, and in some cases immunoblotting, were performed on whole blood collected on filter paper from 603 Kenyans. Serum samples from 55 of these persons underwent the same examinations, and 45 were further examined by immunofluorescence and a commercial ELISA. The majority of the Kenyans examined were residents of a province in West Kenya, while the others were students from other parts of Kenya, predominantly rural areas. Male/female ratio was 62/38. Median age was 18 years (range 0-70). Five Danes with previously demonstrated HIV antibodies, and 10 Danish controls were examined for HIV antibodies in filter paper whole blood, and in serum by ELISA and immunoblotting. The tests carried out on the filter paper blood were found to be reliable. Only one of the examined Kenyans had antibodies to HIV by both ELISA and immunoblotting, representing a prevalence of 0.17% (95% confidence limits: 0.00-0.93%). This low prevalence is not in accord with results previously presented from rural districts in Kenya.

Heterosexual spread of AIDS: a challenge for health education

An arguable over-reaction to the threat of AIDS a year ago has been replaced by over-complacency. Research findings are extensively reviewed, and it is argued that information on heterosexual spread is still insufficient to make confident predictions of its ultimate extent. However, areas for health education can be identified, and future priorities are suggested.

Current issues in developing a strategy for dealing with the acquired immunodeficiency syndrome

A number of current issues exist that must be taken into account in the development of a strategy for dealing with the problem of the acquired immunodeficiency syndrome (AIDS) in the United States and throughout the world. Given the complexity of the problem and the fact that the epidemic is still in its evolving stages, such issues must be considered individually and as a group. The present discussion focuses on several of these critical issues and outlines approaches that might be useful in the formulation of basic scientific and public health strategies for dealing with the currently appreciated and projected problems in AIDS.

Worldwide strategies for HIV control: WHO's special programme on AIDS

The acquired immunodeficiency syndrome (AIDS) and the entire spectrum of disease associated with infection by the human immunodeficiency virus (HIV) are the subject of intense international interest and concern. From the viewpoint of the World Health Organization (WHO), HIV is not simply one of a series of newly recognized diseases emerging during the past decade but is a problem with several biological and epidemiological features that justify a unique sense of urgency among public health officials, political leaders, and the general public.

This article describes the evolution of a global perspective and response to HIV, reviews the current international epidemiological situation, explores the principal elements, both conceptual and operational, of WHO's global strategy for HIV control, and discusses the major approaches to HIV prevention in the current global context.

LAV/HTLV-III infection in children of African origin: experience in Belgium

From December 1982 to June 1985, we diagnosed LAV/HTLV-III infection in 16 children of African origin living in Belgium or referred to one of the hospitals participating in this study. Diagnosis was proven in seven of them by isolation of virus of the LAV/HTLV-III group. In the nine others, LAV/HTLV-III infection was highly probable because of the presence of antibodies against the virus (seven subjects) or clinical and immunological evidence of immune deficiency associated with a parental history of LAV/HTLV-III infection (two subjects). Five of these children had a severe illness starting in the first months of life (range 20 days--4 months) and died within 4 months (range 19 days--10 months). Eight children presented later in life (mean age 35 months, range 2-66 months) with a milder and more chronic disease characterized by the presence of generalized lymphadenopathy (6/8), hepatomegaly (5/8), splenomegaly (5/8), interstitial pulmonary infiltration (4/8), parotid swelling (3/8), CSF lymphocytosis (3/5), diarrhoea without pathogen isolated (1/8) and fever (1/8). At least one of the parents of each child was of African origin. At the time of birth of their child two mothers and one father had an AIDS-related complex. After a mean period of 34 months (range 3-87 months) five fathers and six mothers had a symptomatic LAV/HTLV-III infection (AIDS or AIDS-related complex).

Evidence for heterosexual transmission and clinical manifestations of human immunodeficiency virus infection and related conditions in Lusaka, Zambia

In a hospital-based survey in Lusaka, Zambia, 189 (17.5%) of 1078 subjects had antibodies against the human immunodeficiency virus (HIV). The prevalence of antibodies was low in subjects aged less than 20 or greater than 60 years; in men the peak prevalence (32.9%) occurred in those aged 30-35 years, and in women (24.4%) it occurred in the 20-25 year age-group. There was no significant difference in prevalence by sex after adjusting for age. High educational level was independently associated with HIV seropositivity; the antibody against HIV was found in 18.4% of blood donors and in 19.0% of hospital workers. Among patients the antibody prevalence ranged from 8.7% in antenatal women and 9.3% in orthopaedic patients to 29.2% in those attending sexually transmitted disease (STD) clinics (the prevalence being 37.3% in previous attenders and 22.8% in first-time attenders). Seropositivity rates were higher in patients with an infectious problem (23.4%) than in those without (11.4%, p = 0.0002). Herpes zoster, oral thrush, diarrhoea, tuberculosis, and weight loss were independently correlated with seropositivity. The data strongly suggest that HIV infection is prevalent in Africa and is transmitted heterosexually. The restricted distribution of seropositivity to the sexually active age-groups indicates that the epidemic, at least in this part of Africa, is newly introduced; this has substantial implications for prevention.

Absence of antibodies to the human immunodeficiency virus in sera from Africa prior to 1975

Three different assays for detection of antibodies to the human immunodeficiency virus (HIV) were conducted on 677 sera obtained from 1964 to 1975 from male and female children and adults in Uganda and other countries in Africa. Several sera were collected from individuals with Kaposi sarcoma. No evidence of antibodies to the virus was noted up to 1975. These results strongly suggest that the emergence of HIV in Africa occurred relatively recently. Further studies are required to determine the geographic origin of the acquired immunodeficiency syndrome virus.

Seroepidemiology of human immunodeficiency virus in Africa

Serum samples from 6015 African subjects without symptoms of the acquired immune deficiency syndrome (AIDS) or contact with the disease were examined for antibodies to the human immunodeficiency virus by a combination of an enzyme linked immunosorbent assay and radioimmunoprecipitation (2567 samples) or by immunofluorescence (3448 samples). Serum samples had been collected between 1976 and 1984 in Senegal (n = 789), Liberia (935), Ivory Coast (1195), Burkina Faso (299), Nigeria (536), Gabon (1649), Zaire (15), Uganda (164), and Kenya (433). Only four samples contained antibodies. Three of these were from attenders at the Lambarene clinic in Gabon and one from a villager in Senegal. By contrast, two out of six AIDS suspects from Guinea-Bissau, all 13 patients with AIDS from Kinshasa (Zaire), and two out of three of their contacts were seropositive, all these specimens having been collected in 1985. These data show that fewer than one in a 1000 subjects were seropositive for AIDS at the time of sampling before 1985 and do not support the hypothesis of the disease originating in Africa.

Transmission of human immunodeficiency virus (HIV/HTLV-III/LAV): a review

The literature on the transmission of human immunodeficiency virus (HIV/HTLV-III/LAV) is reviewed. HIV spreads by vertical transmission and by iatrogenic transmission (transfer of blood or blood-containing products), by infected needles among i.v. drug users and, more rarely, among health care workers, but mainly by sexual contact. In Western countries the virus is mainly spread by passive anal intercourse among homosexuals and seldom by heterosexual intercourse. In African countries, however, the virus is mainly spread by heterosexual intercourse, probably because of other, concurring sexually transmitted diseases. Some preventive measures are discussed.

Evaluation of serological cross-reactivity between antibodies to Plasmodium and HTLV-III/LAV

Serum samples from 460 patients with existing or previous Plasmodium infections, high antimalarial antibody titres, and no apparent risk of exposure to human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) were assayed for HTLV-III/LAV antibody; only 1 sample, from a 21-year-old African woman, was strongly reactive by enzyme-linked immunosorbent assay (ELISA) and positive by western blot. Conversely, no sample from 100 HTLV-III/LAV-positive American homosexual men was strongly reactive for antibodies to the four Plasmodium species that infect human beings by an indirect fluorescent antibody technique, or for antibodies to Plasmodium falciparum by an ELISA technique. Thus, exposure to Plasmodium does not result in HTLV-III/LAV seropositivity, and HTLV-III/LAV antibodies are not strongly cross-reactive with malarial antigens.

No evidence of LAV infection in the Republic of Liberia, West Africa, in the year 1973

Sera collected 13 years ago from 592 residents of the Republic of Liberia have been tested for antibodies to LAV polypeptides. 7 sera were positive by ELISA using two commercially available test kits whereas immunoblotting did not confirm antibodies specific for LAV.

Genetic variability of the AIDS virus: nucleotide sequence analysis of two isolates from African patients

To define further the genetic variability of the human AIDS retrovirus, we have cloned and sequenced the complete genomes of two isolates obtained from Zairian patients. Their genetic organization is identical with that of isolates from Europe and North America, confirming a common evolutionary origin. However, the comparison of homologous proteins from these different isolates reveals a much greater extent of genetic polymorphism than previously observed. It is nevertheless possible to define conserved domains in the viral proteins, especially in the envelope, that could be of interest for the understanding of the molecular mechanisms of viral pathogenicity and for the development of diagnostic and therapeutic reagents.

The susceptibility of Cryptococcus neoformans to an antimycotic agent (G2) from alfalfa

Compound G2, 2-beta-hydroxy-3-beta-O-(beta-D-glucopyranosyl)-delta 12-oleanene-23,28-dionic acid, isolated from alfalfa roots, demonstrated considerable activity against Cryptococcus neoformans (MIC value of 2 micrograms/ml). Compound G2 exhibited rapid killing of this fungus (MFC value of 4 micrograms/ml) suggesting that it might be a useful active agent in the treatment of cryptococcosis.

The acquired immunodeficiency syndrome: epidemiology and risk factors for transmission

The acquired immunodeficiency syndromE (AIDS) is a very serious illness caused by a human T-lymphotropic retrovirus: human T-lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV). It primarily affects young adults living in one of several major metropolitan areas. Most patients are homosexual men, but heterosexual men and women have also been affected. Heterosexual men and women who use intravenous drugs, who are hemophiliacs, or who are sex partners of AIDS patients appear to be at increased risk for developing the disease.

Persistent infection of chimpanzees with human T-lymphotropic virus type III/lymphadenopathy-associated virus: a potential model for acquired immunodeficiency syndrome

The lymphadenopathy-associated virus (LAV) prototype strain of human T-lymphotropic virus type III/LAV was transmitted to juvenile chimpanzees with no prior immunostimulation by (i) intravenous injection of autologous cells infected in vitro, (ii) intravenous injection of cell-free virus, and (iii) transfusion from a previously infected chimpanzee. All five animals that received more than one 50% tissue culture infective dose were persistently infected with LAV or chimpanzee-passaged LAV for up to 18 months. During this time they developed no illnesses, but they exhibited various degrees of inguinal and axillary lymphadenopathy and significant reductions in rates of weight gain. Detailed blood chemistry and hematologic evaluations revealed no consistent abnormalities, with the exception of immunoglobulin G (IgG) hypergammaglobulinemia, which became apparent in one animal 6 months postinfection and continued at more than 1 year postinfection. Transient depressions followed by increases in the numbers of T4 cells to levels greater than normal were observed in all animals after virus inoculation. However, the number of LAV-infected peripheral blood cells decreased with time after infection. Results of enzyme immunoassays showed that all infected animals seroconverted to IgG anti-LAV within 1 month postinfection and that antibody titers remained high throughout the period of observation. In contrast, only three of the five LAV-infected chimpanzees had detectable IgM antibody responses, and these preceded IgG-specific serum antibodies by 1 to 2 weeks. Virus morphologically and serologically identical to LAV was isolated from peripheral blood mononuclear cells of all infected animals at all times tested and from bone marrow cells taken from one animal 8 months after infection. One chimpanzee that was exposed to LAV only by sharing a cage with an infected chimpanzee developed lymphadenopathy and an IgM response to LAV, both of which were transient; however, no persistent IgG antibody response to LAV developed, and no virus was recovered from peripheral blood cells during a year of follow-up. Thus, LAV readily infected chimpanzees following intravenous inoculation and persisted for extended periods despite the presence of high titers of antiviral antibodies. However, the virus was not easily transmitted from infected to uninfected chimpanzees during daily cage contact.

Isolation of HTLV-III/LAV from cervical secretions of women at risk for AIDS

Cervical secretions from 14 women seropositive for HTLV-III/LAV were obtained between days 7 and 21 of the menstrual cycle and cultured for virus. HTLV-III/LAV was isolated from cervical secretions in 4 of 14 women, as well as from blood of 7 of 13 women tested. Female genital secretions may therefore be a source for sexual transmission of the virus to men.

AIDS virus infection in Nairobi prostitutes. Spread of the epidemic to East Africa

The acquired immunodeficiency syndrome (AIDS) is epidemic in Central Africa. To determine the prevalence of AIDS virus infection in East Africa, we studied 90 female prostitutes, 40 men treated at a clinic for sexually transmitted diseases, and 42 medical personnel in Nairobi, Kenya. Antibody to human T-cell lymphotropic virus Type III (HTLV-III) was detected in the serum of 66 percent of prostitutes of low socioeconomic status, 31 percent of prostitutes of higher socioeconomic status, 8 percent of the clinic patients, and 2 percent of the medical personnel. The presence of the antibody was associated with both immunologic and clinical abnormalities. The mean T-cell helper/suppressor ratio was 0.92 in seropositive prostitutes and 1.82 in seronegative prostitutes (P less than 0.0001). Generalized lymphadenopathy was present in 54 percent of seropositive prostitutes and 10 percent of seronegative prostitutes (P less than 0.0001). No constitutional symptoms, opportunistic infections, or cases of Kaposi's sarcoma were present. Our results indicate that the epidemic of AIDS virus infection has, unfortunately, spread extensively among urban prostitutes in Nairobi, Kenya. Sexual exposure to men from Central Africa was significantly associated with HTLV-III antibody among prostitutes, suggesting transcontinental spread of the epidemic.

Parasitological observations of chronic diarrhoea in suspected AIDS adult patients in Kinshasa (Zaire)

The parasitological profile of chronic diarrhoea in 46 Zairian adults suspected of Aids demonstrated that the frequency of protozoa was five times higher than that of helminths; 86% of the protozoa were sporozoa: Isospora belli was the most frequent (19%), followed by Cryptosporidium isolated for the first time in Zaire (8%) and Blastocystis hominis (2%). 37 of the 46 patients were immunodeficient.