Henri Taelman

ACQUIRED IMMUNODEFICIENCY SYNDROME IN A HETEROSEXUAL POPULATION IN ZAIRE

38 patients with the acquired immunodeficiency syndrome (AIDS) were identified in Kinshasa, Zaire, during a 3 week period in 1983. The male to female ratio was 1.1:1. The annual case rate for Kinshasa was estimated to be at least 17 per 100 000. Opportunistic infections were diagnosed in 32 (84%) patients, disseminated Kaposis sarcoma (KS) with opportunistic infection in 5 (13%), and disseminated KS alone in 1 patient. Immunological characteristics of these patients were as reported for cases in the USA and Europe, but immunological abnormalities were also found in 6 controls with infectious diseases but no symptoms of AIDS. Female AIDS cases were younger than male patients with AIDS (mean ages 28.4 vs 41.1 years, respectively), and were more often single (14/18 vs 2/20). Homosexuality, intravenous drug abuse, and blood transfusion did not appear to be risk factors in these patients. The findings of this study strongly argue that the situation in central Africa represents a new epidemiological setting for this worldwide disease--that of significant transmission in a large heterosexual population. Two instances of clusters of AIDS (not included in the above series) involving males and females with frequent heterosexual contact further implicate heterosexual transmission.

A Cluster of HIV Infection among Heterosexual People without Apparent Risk Factors

n Human immunodeficiency syndrome (HIV) epidemiology in Belgium shows that 66% of all acquired immunodeficiency syndrome patients were infected heterosexually. Since 1985, all HIV-seropositive patients in Brussels and Antwerp who have been heterosexually infected have been offered participation in a partner notification program; this article reports the case study of 1 HIV infected male and his 19 identified previous women sexual partners. This report describes the patients background and the type and frequency of sexual intercourse he had with each partner. The characteristics of each of the sexual partners were also described. An important consideration of this case was that 11 of the tested partners (56%) were HIV seropositive. Several factors were discussed concerning the cause of this high rate of transmission (e.g. high disseminator patient, highly virulent HIV strain, and presence of genital herpes). This study emphasizes the fact that middle class women with low risk sexual practices were infected with AIDS from as little as 1 sexual encounter with this infected individual. To stop a false sense of security among people with few sexual partners, it was advised that a program of partner notification targeted to heterosexuals be implemented along with other public health policies.n

Difluoromethylornithine, an effective new treatment of gambian trypanosomiasis: Results in five patients

Recent studies have shown DL-alpha-difluoromethylornithine (eflornithine), an inhibitor of polyamine biosynthesis, to be curative in various Trypanosoma species infections of laboratory animals. Five patients are described with Gambian trypanosomiasis treated in Belgium with difluoromethylornithine, using various intravenous and oral dosage schedules. Three patients had late-stage and two had early-stage disease. Difluoromethylornithine treatment was associated with clearing of parasites from blood within one to four days, a trend towards normalization of all altered biologic values associated with the disease, and marked amelioration of clinical symptoms. Side effects of difluoromethylornithine, including loose stools in three patients and both anemia, and a decrease in auditory acuity in one patient, were mild, transient, and never required interruption of drug treatment. The presence of difluoromethylornithine in cerebrospinal fluid, determined in three patients, demonstrated that difluoromethylornithine penetrates into the central nervous system. In three patients, follow-up of at least 24 months after treatment demonstrated a continued healthy state without evidence of relapse. These promising, albeit preliminary, results of difluoromethylornithine therapy, even in patients with central nervous system involvement, indicate that extended clinical trials are warranted to determine the optimal dosage regimen in patients with early- and late-stage disease.

Acquired Immune-deficiency Syndrome in Belgium and its Relation To Central-africa

During the years from 1979 until 1983, 40 cases of CDC-defined AIDS were seen in Belgium. Only two patients were Belgian male homosexuals. The other patients were Central Africans who lived in Belgium or who had travelled to Belgium for medical care. There was no evidence of an underlying immunosuppressive disease, and no history of homosexuality or intravenous drug abuse. The male:female ratio was 1.5. All patients had opportunistic infections. Five of them also had Kaposis sarcoma. All patients tested had immunologic features of severe T-cell depression. The overall mortality was 42.5 percent. It is likely that AIDS is endemic now in Central Africa, and that the cases seen in Belgium represent only the tip of the iceberg.

Acquired immunodeficiency syndrome (AIDS) in Africa: a review.

Acquired immunodeficiency syndrome (AIDS) has been reported in patients from Zaire Congo Rwanda Kenya Burundi Angola Mali Central African Republic Gabon Cameroon Chad Zambia and Uganda. Preliminary data suggest that AIDS occurs endemically in Central Africa. Most African AIDS patients do not belong to the major high risk groups identified in the US and the disease occurs with almost equal frequency in both sexes. African patients generally have multiple sexual partners have traveled frequently and often have a history of sexually transmitted diseases. The most striking clinical manifestations of AIDS in African patients are profound weight loss severe chronic diarrhea and fever of unknown origin. Generalized lymphadenopathy has been detected in 50% of Zairian AIDS patients and in 76% of Rwandan AIDS patients. Opportunistic infections and malignancies found in African AIDS patients have included thrush cryptococcosis cryptosporidiosis and Isospora belli infection herpes simplex infection cytomegalovirus infection aggressive Kaposis sarcoma Pneumocystis carinili pneumonia Strongyloidasis tuberculosis generalized atypical mycobacterial infection cerebral toxoplasmosis and cerebral lymphoma and parasitic infections. Immunologic abnormalities are similar to those found in US AIDS patients. Although the mode of transmission of AIDS in Africa remains unknown the possible role of scarifications unsterile injections and transfusions needs investigation. Preventive measures recommended include avoidance of sexual contact with multiple partners use of condoms when the sexual partner belongs to a risk group and use of properly sterilized syringes and needles.

Impact of human immunodeficiency virus infection on tuberculosis in Kigali, Rwanda: One-year study of 377 consecutive cases

Abstract Objectives: To analyze and compare the clinical, diagnostic, and therapeutic features of tuberculosis (TB) in human immunodeficiency virus (HIV)-seropositive and seronegative patients. Methods: A 1-year retrospective review of medical records and charts of TB patients admitted to and followed-up at the Department of Internal Medicine of the Centre Hospitalier de Kigali (CHK), Kigali, Rwanda. Results: Tuberculosis was diagnosed in 510 patients. Complete data, including HIV serologic testing, were available for 377 patients (74%) of whom 227 were male and 150 female, aged 17–70 years (mean, 33 y). Human immunodeficiency virus antibodies were detected in 334 (88.6%) of the 377 evaluable patients. A definite diagnosis of TB was established in similar proportions of HIV-seropositive (66%) and HIV-seronegative (63%) patients. The HIV-infected patients differed from the patients without HIV infection in the following features: proportion of patients in the age group 20–39 years (80% vs. 58%; P=0.001), extrapulmonary manifestations (56% vs. 40%; P=0.045), lower/middle lobe infiltrates (18% vs. 6%; P=0.07), presence of cavities (15% vs. 34%; P=0.002), pleural disease (23 vs. 12%; P=0.08), tuberculin anergy (67% vs. 26%; P Conclusions: Active TB was strongly associated with HIV infection in urban Rwanda. The clinical and radiographic presentation of TB, described in HIV-seropostive patients hospitalized at teh CHK, is most frequently atypical and highly suggestive of advanced HIV disease.

Polyarthrite post-méningococcique : à propos d'un cas

Resume Une patiente de 18 ans developpe une meningite a meningocoques A avec meningococcemie se compliquant dune polyarthrite post-meningococcique sous traitement antibiotique adapte, necessitant le recours a un traitement anti-inflammatoire. Une revue de la litterature est presentee et les particularites du cas sont analysees.