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    Global epidemiology. AIDS -- a global perspective.

    Von Reyn CF; Mann JM

    WESTERN JOURNAL OF MEDICINE. 1987 Dec; 147(6):694-701.

    This article describes AIDS case definitions and reporting and the problems with serologic studies of HIV antibody detection. These problems include technical limitations of HIV antibody testing, false positive results due to the presence of malaria antibodies, and cross reactions between HIV 1 and HIV 2. There is a summary of the three basic modes of transmission: sexual, perenteral, and perinatal. Geographic patterns of transmission differ with the frequency of the three modes of transmission and the ways in which HIV infection occurs in different cultures. Three patterns are identified. Pattern I involves homosexual and bisexual transmission with some heterosexual transmission and significant perenteral transmission through intravenous (IV) drug use. Population seroprevalence is 1%. Countries with this pattern are North America, Europe, some areas of South America, Australia, and New Zealand. Pattern II involves larger risk groups and heterosexual transmission. There is high seroprevalence among women, and, as a result, perinatal transmission is evident. Seroprevalence is >1%. Examples of this pattern are central, eastern and southern Africa and Haiti. In Pattern III, the phenomena is recent and transmission is homosexual and heterosexual, particularly among prostitutes or persons from known HIV endemic areas. Imported blood and blood products have contributed to parenteral transmission. Middle Eastern and Asian countries exemplify this pattern. The global epidemiology is discussed by region: the Americas, Europe, Africa, and Oceania. Case reports from 127 countries to WHO have totaled 62,811 in 1987. 70% of the cases reported are from the United States. The estimated number of AIDS cases worldwide is 100,000-150,000, and HIV infected people are thought by WHO to number 5-10 million. In the United States, reported AIDS cases continue to double every year. There is some evidence for stabilization in at least one homosexual population. Between 1985-86, there was a 130% increase in heterosexual the number of heterosexuals (mostly women) who acquired AIDS from contact with IV drug users or bisexual men. Brazil has the second largest number of cases and follows Pattern I. Europe reported 5687 cases by 1987 compared to 44,000 for the US. The highest rate of AIDS cases in Europe is from Switzerland at 34.9/million (which compares to 140.2/million in the US). 50% of the reported cases in Europe are in people from Africa or the Caribbean. African AIDS is distinguished by 50% of cases being in women. AIDS cases from transfusion are still a problem. Perinatal transmission occurs. Nonmedical parenteral transmission (ritual scarification, circumcision, and so on) and medical injections play a role in transmission of HIV infection among children. Surveillance has improved. Oceania reported 569 cases by 1987. Australia has the highest rate in Oceania at 23.8/million and a male to female sex ratio of 26:1; pattern I predominates. Other countries which have reported cases are Thailand, Japan, the Philippines, Israel, and 2 cases from China.
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