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BMJ. British Medical Journal. 1992 Aug 8; 305(6849):325-6.The press widely publicized investigative findings at the international AIDS conference in Amsterdam, the Netherlands about patients with signs or symptoms consistent with AIDS or AIDS-related complex but who did not have HIV-1 or HIV-2 antibodies or the viruses themselves. Yet the formal scientific sessions ignored this topic and the conference summaries only casually mentioned it. Tests used to try to detect HIV were antibody testing, virus isolation, or molecular detection techniques. The press suggested several emotive questions not based on clinical data such as the safety of national blood supplies. 4 of the 5 patients in New York City had HIV risk factors. The only clinical indications of immunodeficiency in 1 patient was Mycobacterium tuberculosis infection and 2 somewhat low CD4 counts which may have actually been due to tuberculosis. Laboratory personnel have not yet reconfirmed reverse transcriptase activity of lymphocytes from 2 patients. So far these cases do not exhibit epidemiological criteria for a new transmissible agent. There has been no case clustering or a pattern of sexual or vertical association of cases. These cases may only be more detections of cases of rare spontaneous primary or secondary immunodeficiency disease. If epidemiological support does suggest a transmissible agent, laboratory personnel may find it difficult to isolate and identify agent. The US Centers for Disease Control and WHO wants to coordinate reporting and classification of cases so epidemiologists can quickly verify or reject laboratory findings based on a larger series of cases. Only with full evaluation of ongoing research and development of sensitive and specific detection systems for new pathogens can the scientific community address questions concerning the safety of blood supplies. This reaction of the press indicates a need for the peer review system to continue to establish the soundness of research before its release to the press to avoid undue concern.
FAR EASTERN ECONOMIC REVIEW. 1992 Feb 20; 28-9.As the AIDS epidemic and HIV transmission in India increasingly resembles that observed in sub-Saharan Africa, Indian society's arrogant perception of invulnerability to the pandemic is proving to be considerably ill-conceived. The dimensions of the epidemic have multiplied greatly since AIDS was 1st identified among prostitutes in Madras, with the trends observed in Maharashtra and Tamil Nadu being especially ominous. AIDS has forced Indian society and research professionals to acknowledge the existence of domestic prostitution, homosexuals, and drug users. While only 103 AIDS cases and 6,400 HIV infections have been officially identified, it is clear that these cases represent only a tiny fraction of the true extent of the epidemic in India. The government will therefore spend up to US$7.75 million on an anti-AIDS program aimed at ensuring secure blood supplies, and checking heterosexual transmission through education and the promotion of condoms. The program also targets IV-drug users and truck drivers for education and behavioral change. India is the 2nd country after Zaire to accept foreign loans for such a purpose. It will receive US$85 million over 5 years from the World Bank in addition to supplemental funds from the WHO and the U.S. Weak attempts, however, have been made to test blood supplies, with only 15% being tested in Tamil Nadu. A large gap also remains between health educators and needy target groups. Finally, while some top officials realize the need for immediate action against AIDS, broad public awareness and coping will come only after AIDS mortality begins to mount in the population.
WORLDAIDS. 1992 Jan; (19):11.In 1991, researchers followed 212 mothers and infants who tested HIV-1 negative at delivery in Rwanda. Later 8 infants tested HIV positive. Both the infants and mothers became infected simultaneously. They ruled out other routes of infection and concluded that the colostrum and breast milk were possibly the route of infection for 4 infants and positively the route for 4 infants. They postulated that when one 1st becomes infected with HIV, one may have high levels of HIV in the blood and thus be more infectious in the time period between 1st contracting HIV and development of HIV antibodies. All the mothers were vulnerable to sexual exploitation because they were either unmarried or widowed or had absent husbands and unstable sexual partnerships. Thus the risk factor of economic and social instability enhanced their vulnerability to exposure to HIV. The researchers suggested that heal professionals should counsel HIV negative mothers who are at high risk about the possibility of transmitting HIV via breast milk if they happen to seroconvert. In some developing countries like Rwanda, no alternatives to breast feeding exist so the researchers advocated intervention studies to assess the efficacy and feasibility of alternative nutritional practices, such as wet nursing, for mothers at high risk of acquiring HIV after delivery. They did not conclude that already HIV infected mothers should not breast feed since research had not yet proved that infants acquire HIV from breast milk of infected mothers. In fact, other research showed that HIV positive infants who are breast fed live longer than bottle fed HIV infants. After publication of this study, WHO continued its commitment to promote, protect, and support breast feeding no matter what the HIV prevalence of a country is.