Clinical manifestation of HIV infection in Northern Zaire [letter]
Commentary is directed to the effectiveness in low HIV seroprevalence countries of the use of the 1985 Centers for Disease Control/World Health Organization (CDC/WHO) clinical case definitions for AIDS. A study of HIV-1 and HIV-2 seroprevalence was conducted at the Regional Hospital of Gbadolite, Northern Zaire, in order to examine the relationship between clinical symptoms and the presence of HIV infection. The results showed that in a sample of 667 healthy subjects, who were blood donors and surgical patients without HIV symptoms, 8.2% were HIV-1 seropositive. 30 men (5.8%) and 25 women (17.1%) out of the 521 had HIV-1 antibodies, and no one had HIV-2 antibodies. A sample of 465 patients, who had at least one minor or major clinical symptom of AIDS corresponding to the CDC/WHO clinical case definition, showed 54 of the 200 men (27%) and 129 of the 265 women (48.7%) as seropositive. The conclusion was that specificity was poor for diagnosis of AIDS based on clinical case definitions. In another sample of 143 patients, different from the CDC/WHO clinical case definitions were: pyogenic abscess, tubo-ovarian abscess, epididymitis/orchitis, condylomata acuminata, piles, vaginal ulcerations, recurrent abortions, and amenorrhea/infertility. Further investigations of clinical symptoms are still needed, particularly where expensive testing for HIV infections is curbed by shortages in funding. Technical barriers also prevent reliable and practical HIV testing. It is recognized that the CDC/WHO definition was valuable in detecting cases in Uganda. Other field studies among African populations with HIV seroprevalence of 34-42% showed that the CDC/WHO definition had a specificity of 85-90%, a sensitivity of 55-59%, and a positive predictive value of 73%.