Antibody to HTLV-III in blood donors in central Africa

Nosocomial Transmission of HIV in Africa: What Tribute Is Paid to Contaminated Blood Transfusions and Medical Injections?

We reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.

Blood transfusions in the early years of AIDS in sub-Saharan Africa

Blood transfusions transmit HIV more effectively than other means, yet there has been little examination of their role in the origins and early course of AIDS in sub-Saharan Africa. We review historical data in archives, government reports, and medical literature from African and European sources documenting the introduction, establishment, use, and growth of blood transfusions in sub-Saharan Africa. These data allow estimation of the geographic diffusion and growth of blood transfusions between 1940 and 1990. By 1955, 19 African colonies and countries reported transfusion programs-with national rates of 718 to 1372 per 100 000 by 1964, and urban rates similar to those in developed countries. We estimated 1 million transfusions per year in sub-Saharan Africa by 1970 and 2 million per year by the 1980s, indicating that transfusions were widely used throughout sub-Saharan Africa during the crucial period of 1950-1970, when all epidemic strains of HIV first emerged in this region.

How well are hospitals preventing iatrogenic HIV? A study of the appropriateness of blood transfusions in three hospitals in the Ashanti region, Ghana

A study on the appropriateness of blood and blood product transfusions took place in three hospitals over a 3-week period in July/August 1990 in the Ashanti region of Ghana. Clinical records of all blood transfusion recipients within the period were examined for the appropriateness of the transfusions based on preset criteria. Nearly 1 in 5 (17%) of all blood transfusion episodes in the hospitals were avoidable according to these criteria. Surgical practices were associated, perhaps habitually, with many more avoidable blood transfusions than non-surgical medical practices. The need to minimize the use of transfusion therapy is reemphasized since human immunodeficiency virus screening is imperfect. There is the need for hospitals to develop reasonable, practical guidelines for transfusions in all departments.

Evaluation on HIV serology and immune-stimulation on patients in Tanzania

Antibodies against human immunodeficiency virus, other infectious agents and neopterin levels were determined in 253 patients in a rural area of North-West Tanzania. Seroprevalence for HIV was 3.2%. In one case serology was positive for HIV-1 and HIV-2 antibodies and questions whether there was a real double infection or a cross reaction not only concerning core region proteins but also transmembrane protein. The specificity in the diagnosis of HIV-infection is markedly increased with newer serological methods using recombinant peptides but did not improve sensitivity on African sera. Neopterin was determined as a sensitive indirect marker for the activation of T-cells and is therefore correlated with the susceptibility of HIV infection and with progression of disease. High seroprevalence rates for various infectious agents were determined and may explain the high rate of elevated neopterin levels in 80% of the Africans. Neopterin levels were even higher in HIV patients. Viral p24 antigen was found only in two persons, one of whom had no antibodies detectable.

Performance and cost-effectiveness of a dual rapid assay system for screening and confirmation of human immunodeficiency virus type 1 seropositivity

Recent studies have shown that rapid, instrument-free assays for the detection of antibody to human immunodeficiency virus (HIV) can be as sensitive and specific as enzyme-linked immunosorbent assay (ELISA) for screening of donated blood in developing countries. Currently, however, specimens which test positive on a screening assay must still be confirmed by Western blot (immunoblot), a method which is not feasible in most developing-country laboratories. We examined whether a testing hierarchy which utilizes neither conventional ELISA nor Western blot can be reliably used for screening and confirmation of HIV infection in a high-risk population. In a retrospective analysis of 3,878 specimens which were screened for antibody to HIV in Kinshasa, Zaire, we observed that a testing hierarchy consisting of duplicate HIVCHEK screening assays followed by duplicate Serodia-HIV confirmatory assays resulted in correct confirmation of all ELISA- and Western blot-positive specimens. We conclude that such a testing hierarchy can produce highly accurate results for identification of positive specimens in routine HIV testing and provides a practical alternative to conventional methods of HIV screening and confirmation.

Adult gonococcal keratoconjunctivitis with AIDS

Gonococcal eye infection in adults is an uncommon cause of blindness, where prompt diagnosis and effective treatment are essential in the prevention of ophthalmic morbidity. We present a case report detailing the management and complications encountered in this condition in a patient coinfected with human immunodeficiency virus (HIV).

Serological survey of human immunodeficiency virus (HIV) in Ethiopia

The presence of anti-human immunodeficiency virus 1 antibodies was tested in 5,565 serum samples from Ethiopia of which 5,265 were collected from military recruits in the framework of a hepatitis B (HBV) seroepidemiological study performed on a national scale in 1985-1986; the remaining were 300 sera from a population of outpatients belonging to the Arsi region. Of the 5,565 sera, 121 (2.1%) were found to be repeatedly reactive by enzyme-linked immunosorbent assay (ELISA) test for HIV-1 antibodies, but these reactivities were confirmed by Western Blot (WB) assay in only four cases (0.07%) and by ENVACOR (confirmatory competitive ELISA) in three samples. Twenty-three sera were positive by WB to one or two bands related to core proteins but were all negative by ENVACOR. However, according to accepted criteria for positivity, these sera must be regarded as indeterminant reactors. A sample of 409 sera, both reactive and nonreactive by HIV-1 ELISA, were further tested for antibodies to HIV-2 by ELISA. Reactive sera were analysed by WB and by radioimmunoprecipitation assay (RIPA) using 35S-cysteine metabolically labelled SIVmac (HTLV-IV) infected cell lysates. Only 11 sera were found to be slightly reactive in ELISA, but this was not confirmed by WB or RIPA. Data indicate that HIV infection was not widespread in the general population of Ethiopia up to 1986.

Field testing and comparative evaluation of rapid, visually read screening assays for antibody to human immunodeficiency virus

Five rapid, visually read assays for detection of antibody against human immunodeficiency virus (HIV) were evaluated on fresh serum samples from 4000 prospective blood donors at Mama Yemo Hospital, Kinshasa, Zaïre. The sensitivity of the assays, based on 214 specimens positive by western blot, ranged from 84.6% to 99.1%. The specificity, based on 3664 samples negative by enzyme-linked immunosorbent assay (ELISA) or western blot, ranged from 92.7% to 98.8%. Three readers scored each test result independently; disagreement about test interpretation occurred in 1.2-8.3% of the specimens. There was no correlation between assay performance and assay principle (agglutination or dot immunobinding) or antigen source (viral lysate or recombinant). Assays such as these can be readily implemented in a developing country transfusion centre, where blood screening by ELISA is not practicable.

HIV infection in developing countries

Shortly after the first reports on the acquired immunodeficiency syndrome (AIDS) in the United States, it became clear that the disease was also particularly frequent in Haitians living in North America (Pitcheniket at., 1983; Curranet al., 1985) and in Africans seen in Europe for medical care (Katlamaet al., 1984; Clumecket al., 1984). Subsequently, surveys in Haiti and in Central Africa confirmed the occurrence of epidemic foci of AIDS in these areas (Papeet al., 1983; Malebrancheet al., 1983; Piotet al., 1984; Van de Perreet al., 1984).

Nosocomial transmission of HIV in Africa: what tribute is paid to contaminated blood transfusions and medical injections?

We reviewed the published data on the possible impact of medical injections and blood transfusions on the spread of human immunodeficiency virus (HIV) in Africa. We also compared these results to our experience in Rwanda, central Africa. The importance of medical injections in the epidemic of HIV infection seems to differ from one area to another. The excess of injections experienced by HIV seropositive subjects in Zaire could be secondary to the parenteral treatment of early HIV-related illness or to the treatment of sexually transmitted diseases, rather than being the cause of HIV infection, as suggested by Rwandese studies. In contrast, blood transfusions have been shown to represent an important source of nosocomial HIV infection in many African countries. Effective and relatively inexpensive measures to diminish the iatrogenic spread of HIV infection in developing countries are summarized.

The many epidemiological faces of AIDS with special reference to Hong Kong and implications for prevention and control

There are global differences in the epidemiological picture of the acquired immunodeficiency syndrome (AIDS) and its virus the human immunodeficiency virus (HIV). In Central Africa, AIDS has occurred predominantly in the sexually active age group, with a male to female ratio of 1.1: 1. The infection has been transmitted primarily by promiscuous heterosexual activity. In contrast, in the USA, the major groups at risk are male homosexuals, intravenous drug abusers and haemophiliac patients. Most of the infections have also occurred in the sexually active age group of 20 to 39 years, but the male to female ratio of reported cases was 19: 1. Similar risk groups have been affected in most of the developed countries in America, Europe and Australasia.

In Hong Kong, the three imported cases were all males with histories of sexual encounters abroad. Two were self-professed homosexuals or bisexuals, and the third admitted heterosexual contact with prostitutes. HIV infection has not been detected in intravenous drug abusers. Of the 61 HIV infections detected, 44 (72%) were in haemophiliac patients and 12 (19.8%) In homosexual or bisexual men. Only two infections were seen in women infected by transfusion of blood components in 1984 when safer products were unavailable.

Early preventive measures were taken in Hong Kong, including establishing an AIDS Expert Advisory Committee that informed the public about the facts on AIDS and gave clear guidelines to health care personnel. They were effective in averting the emotive reactions and hysteria to AIDS encountered in many developed countries. In recognition of the importance and need for epidemiological data, a seroepidemiologlcal programme was initiated in April 1985 to identify the groups infected and the extent of the infection. Universal blood donor unit screening for HIV antibody and the introduction of heat-treated Factor VIII were measures implemented to reduce parenterally acquired infections. An AIDS Education and Publicity Committee has also been assembled to heighten public awareness and to disseminate knowledge on the measures available to reduce the risk of infection. An anonymous and confidential AIDS Counselling and Consultation Clinic was established to provide an alternative testing site and to of fer advice and counselling to individuals at risk of infection.

Seroepidemiological study on sexually transmitted diseases and hepatitis B in African promiscuous heterosexuals in relation to HTLV-III infection

A seroepidemiological study was performed on HTLV-III, T. pallidum, C. trachomatis and Hepatitis B virus (HBV), in Butare, Rwanda, among 33 female prostitutes, 25 male customers of prostitutes, and 60 male and female controls. As compared with female controls the prostitutes had a higher prevalence of antibodies to HTLV-III (29/33 versus 4/33, p less than 0.001), T. pallidum (TPHA: 27/33 versus 6/33, p less than 0.001; RPR: 19/33 versus 2/33, p less than 0.001; FTA-Abs: 27/33 versus 5/33, p less than 0.001) and C. trachomatis (IgG IF: 31/33 versus 13/33, p less than 0.001). HBV serological markers were more often detected in the prostitutes than in the female controls (31/33 versus 18/33, p less than 0.001) although HBs antigen carriage rate was similar in both groups. As compared with male controls, the male customers of prostitutes had more frequently detectable antibodies to HTLV-III (7/25 versus 2/27, p = 0.05), and a positive RPR (10/25 versus 1/27, p less than 0.01). Among the 118 individuals studied, odds ratios and trend analysis disclosed a significant association between HTLV-III seropositivity and a positive TPHA, RPR, FTA-Abs, Chlamydia IgG IF test and serological markers to HBV. No association was found between HTLV-III seropositivity and HBs Ag carriage. This study suggests that HTLV-III has to be considered as an infectious agent transmitted among promiscuous Central African heterosexuals by sexual contact and/or parenteral contact with unsterile needles used for STD treatments.

Rapid, easy, and economical screening test for antibodies to human immunodeficiency virus

A new dot enzyme immunoassay (EIA) with a conserved portion of the envelope protein of the human immunodeficiency virus (HIV) as antigen has been designed for use in areas with few laboratory facilities and by personnel with little laboratory experience. Sera were tested in 263 subjects who had AIDS or AIDS-related complex or were at-risk or not-at-risk of AIDS from the USA, Africa, and Asia/Oceania. The dot EIA was 100% sensitive in the American subjects, and there were only 2 false negatives in the others, both of which were negative by commercial EIA. The test is simple to perform, economical, rapid (30 min), and stable.

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.