A 1987 article from dr. Konotey-Ahulu. I wonder how much has really changed.
Alex
Unreliability of seroepidemiology
If seroepidemiology had been consistently reliable in defining correctly the seriousness
of Africa's AIDS problem there would have been less disquiet about it in the countries
I visited. But Biggar et al described very high rates of seropositivity in Kenya5 and
eastern Zaire6, only to remark a year later, "We now believe that the reactivity reported
was not specific" for human T cell lymphotropic virus type III (HTLV III)7-a conclusion
already arrived at by the more extensive investigations of a team of German and British
workers.8 9 Indeed, using more than 6000 samples from African subjects, Wendler et
al showed "that fewer than one in a 1000 were seropositive for AIDS at the time of
sampling before 1985 and (the data) do not support the hypothesis of the disease
originating in Africa."9 This information came too late to prevent extravagant projections
of the AIDS problem in Africa10 and to restore the confidence of Africans in
seroepidemiology. Investigators with a knowledge of tropical medicine quite rightly
observed that "associated with recurrent malaria and other infectious diseases,
excessively high rates of false-positivity with H9/HTV-11I ELISA have led to a
dichotomy between seroepidemiology and clinical epidemiology in tropical Africa.11
In addition, "patients with alcoholic liver disease have a high incidence of false positive
results on tests for HTI-V-III antibodies,"12 while acute malaria infections have
produced false positivity even with the Western blot.13 When the conclusions of
clinical epidemiology differ from those of seroepidemiology clinicians should always
believe the former. Clinicians with considerable experience of Africa told Biggar
that if AIDS had existed there while they were practising they would have recognised
it, but he seemed to dismiss their conviction and described "this type of evidence" as
anecdotal.14 He came to agree with them only after "reviews of the records of the
Belgian and French hospitals" at which Africans were treated, concluding that AIDS
became common only after 1980.14 During my travels through sub-Saharan Africa
I was heartened to observe that there are enough trained health workers in post who
can work out the clinical epidemiology of AIDS a la Cicely Williams and Burkitt with
a minimum of fuss. Granted, seroepidemiology seems to be the more "scientific," but
really it achieves less and uses more resources. When Jonathan Mann wrote recently
that "It is difficult to gauge the spread and seriousness of AIDS in Africa. African
countries lack diagnostic equipment and testing facilities"15 he must have been
referring to seroepidemiology. Primary health care in Ghana, for instance, is so
good that there is no difficulty in tracing patients with AIDS and their relatives,
and a field unit in south western Uganda does not have to rely on seroepiderniology
to gauge the spread and seriousness of AIDS in Africa. I cannot, of course, speak
for Zaire, which was the only country that turned down my application for a visa so
that I could visit medical colleagues and discuss health problems.
http://www.sicklecell.md/aidsinafric...2_cvref103.htm
