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AIDS. 1993 Dec; 7(12):1613-5.In 1990, Belgium, physicians enrolled 415 consecutive patients attending HIV reference centers in Antwerp, Brussels, and Ghent in a cross-sectional study designed to evaluate the clinical axis of the WHO staging system with and without the lymphocyte stratification proposed by Montaner el al. (that is, modified WHO staging system) (>1500, 1500- 1000, and <1000 cells x 1 million/l). They filled in a standardized questionnaire with all criteria of the WHO staging system. Laboratory personnel used standard hematology and flow cytometry techniques to determine absolute and CD4 lymphocyte counts. 80% of the patients were Caucasians. 46% of all patients were homosexual and 42% were heterosexual; 79.2% were men. Median CD4 lymphocyte counts fell in both staging systems as the stage of HIV infection increased. There were significant differences in median CD4 counts between stages of each staging system (p < .001). The modified WHO staging system's stage I was more sensitive at identifying patients with CD4 lymphocyte counts of more than 500 cells x 1 million/l than the WHO clinical stage 1 (83% sensitivity vs. 48% sensitivity). The positive predictive value of WHO clinical stage 4 and of the modified WHO staging system's stage IV for identifying people with CD4 lymphocyte counts of less than 200 cells x 1 million/l was quite high (79% and 80%, respectively). The researchers suggested that clinicians use stages 4 and IV as end-points is clinical trials in developing countries. Clinicians completing the questionnaire knew the patients' earlier CD4 lymphocyte count, which may have introduced a bias in the study. For example, they may have more thoroughly examined patients with low CD4 lymphocyte counts than those with normal counts. Nevertheless, the study's results indicated that either one of these systems may be a good alternative in developing countries to the technical equipment-dependent CD4 lymphocyte count-based HIV staging system used in developed countries. Cohort studies in developing countries would evaluate their prognostic value.
ANTIBIOTICS AND CHEMOTHERAPY. 1991; 43:1-13.Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.
MMWR. Morbidity and Mortality Weekly Report. 1986 Jan 24; 35(3):35-46.As of September 30, 1985, 1573 cases of acquired immunodeficiency syndrome (AIDS) had been reported by the 21 European countries that are participants in the World Health Organization (WHO) European Collaborating Center on AIDS. An average increase of 27 new cases/week has been noted. Of the total cases, there have been 792 deaths, for a case-fatality rate of 50%. The greatest increases in numbers of AIDS cases have occurred in the Federal Republic of Germany, France, the UK, and Italy. The highest rates exist in Switzerland (11.8), Denmark (11.2), and France (8.5). 65% of European AIDS patients have 1 or more opportunistic infection. 20% had Kaposi's sarcoma, alone, and 13% had opportunistic infections with Kaposi's sarcoma. 92% of cases have involved males, and 42% fall into the 30-39-year age group. Of the 1330 (85%) cases involving Europeans, 78% were homosexual or bisexual men, 70% were intravenous drug abusers, and 2% had both these risk factors. Africans have contributed 10% of European AIDS cases. A questionnaire on public health measures related to blood transfusion found that systematic screening of blood donors for lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) antibodies became effective in 16 of the 21 European countries between June-November 1985. Screening is compulsory in 13 countries. The test used is the enzyme-linked immunosorbent assay (ELISA). Portugal is the only country to have organized a national register of seropositive blood donors, although Norway is considering such a register. Methods to exclude donors at risk have been taken in all the countries except Czechoslovakia, Finland, and Portugal. Although male homosexuals account for 69% of reported AIDS cases in Europe, there has been an increase in cases among intavenous drug abusers from 2% of the total in July 1984 to 8% in September 1985. Over 40% of AIDS cases in Italy and Spain occurred in this group. Moreover, several studies carried out in 1985 showed a high frequency (20-50%) of serologic markers of LAV/HTLV-III infection in intravenous drug abusers.