'Silent' HIV infection among wives of seropositive HIV carriers in the Ethiopian community in Israel

Methods to estimate the number of orphans as a result of AIDS and other causes in Sub-Saharan Africa

OBJECTIVE

To derive methods to estimate and project the fraction of children orphaned by AIDS and other causes.

METHODS

HIV/AIDS affects orphan numbers through increased adult and child mortality and reduced fertility of HIV-positive women. We extend an epidemiologic and demographic model used previously to estimate maternal orphans to paternal orphans. We account for the impact of HIV/AIDS on child survival by modeling the HIV status of the partners of men who die of AIDS or other causes based on data on the concordance of heterosexual partners. Subsequently, the proportion of orphans whose parents have both died is predicted by a regression model fitted to orphanhood data from 34 national demographic and health surveys (DHSs). The approach is illustrated with an application to Tanzania and compared with DHS estimates for the years 1992 and 1999.

RESULTS

Projections of the number and age distribution of orphans using these methods agree with survey data for Tanzania. They show the rise in orphanhood over the last decade that has resulted from the HIV epidemic.

CONCLUSIONS

The methods allow estimation of the numbers of children whose mother, father, or both parents have died for countries with generalized heterosexual HIV epidemics. These methods have been used to produce orphan estimates for high-prevalence countries published by Joint United Nations Program on HIV/AIDS, World Health Organization, United Nations Children's Fund, and US Agency for International Development in 2002 and 2004.

Can we find a solution to the human immunodeficiency virus/acquired immune deficiency syndrome controversy? Is acquired immune deficiency syndrome the consequence of continuous excessive stressing of the body?

The time of re-evaluation of the role of human immunodeficiency viruses in the pathogenesis of acquired immune deficiency syndrome has now come, now that methods are available for the direct detection of human immunodeficiency viruses and for the detection of cellular anti-human immunodeficiency virus immune reactions. It has been shown that human immunodeficiency virus infections are common among anti-human immunodeficiency virus antibody negative high-risk individuals. The disease is brought under control by cellular immune reactions and the anti-human immunodeficiency virus antibody test remains negative. Apart from proof that infection with human immunodeficiency viruses has occurred, a positive result in an anti-human immunodeficiency virus-antibody test is also an indication of an independent immunosuppression state. According to the definition of the Centers of Disease Control classical acquired immune deficiency syndrome is the consequence of infection with human immunodeficiency virus in association with continuous excessive stress, such as observed in the known risk groups. At the center of the pathogenetic process is hypercortisolism-determined damage of T lymphocytes, in which insufficiency of thymus is prominent. For this reason, in our view, there are indications for shifting efforts from the prophylaxis of infection with human immunodeficiency viruses to the prophylaxis of acquired immune deficiency syndrome by reducing stress factors.

Immune activation is a dominant factor in the pathogenesis of African AIDS

The AIDS epidemic in Africa is very different from the epidemic in the West. As suggested here by Zvi Bentwich, Alexander Kalinkovich and Ziva Weisman, this appears to be primarily a consequence of the over-activation of the immune system in the African population, owing to the extremely high prevalence of infections, particularly helminthic, in Africa. Such activation shifts the cytokine balance towards a T helper 0/2 (Th0/2)-type response, which makes the host more susceptible to infection with human immunodeficiency virus (HIV) and less able to cope with it.