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September 1985, Volume 35, Issue 9


Acquired Immune Deficiency Syndrome-EpidemioIogy and Etiology

Iftikhar Ahmed  ( Zafar Research and Diagnostic Centre, 7/14 Rimpa Plaza, M.A.Jinnah Road, Karachi. )

This mysterious disease was first reported in June 1981 by the Centre for Disease Control (CDC) United States, when 5 cases of Pneumocystis Carnii pneumonia presented in homosexual men. Within a couple of months the CDC received reports of Kaposi’s Sarcoma (a rare malignant tumor) in homosexual males some of whom also had Pneumocystis Carnii Pneumonia. By mid 1983, over a thousand cases of AIDS had been reported 90% of these were from the large metropolitan cities of US.1
The CDC defines AIDS as “a Disease presenting with a defect in cell mediated immunity occurring in a person with no known cause for diminished resistance to that disease”. Majority of patients are homosexual2 or bisexual3. However heterosexual persons are also at risk2. AIDS has also been reported in Haemophiliacs5-7 in patients receiving blood transfusion8,9 from affected donors or those who subsequently develop the disease, in female sex partners of affected patients2,10 in infants of affected mothers11 and in Haitian refugees in the US12
The etiology of AIDS has yet not been clearly elucidated. The common denominator in all patients is a severe and selective cell mediated immune deficiency. Viruses have been proposed to cause AIDS because of the epidemiologic observations made, however their identity is subject to speculation. Attention has been focussed upon CMV, EBV, HBV and Lymphotropic retroviruses. CMV is known to be immunosuppressive and can be sexually transmitted, most of the homosexuals have serologic evidence of CMV infection. Moreover serologic evidence of CMV infection is present in Kaposi’s Sarcoma. DNA has been demonstrated in the genome of Kaposi Sarcoma Cells13. EBV infects B rather than T lymphocytes. The high EBV antibody titres in most AIDS patients is probably an effect rather than the cause of immunedeficiency14 Hepatitis B virus has been proposed as the agent responsible for post transfusion AIDS and AIDS in Haemophiliacs, HBV. DNA has been demonstrated in leucocytes of some patients with AIDS15,16. Of recent interest are the Lymphotropic retroviruses (HTLV I & III, Type D retrovirus, LAV & IDAV). Human T cell leukemia virus Type I can infect and suppress T cells. Anti HTLV antibodies have been demonstrated in AIDS patients and in a few cases HTLVDNA found in the T cell genome18. HLTV III related to HLTV I has also been demonstrated19,20 French investigators have isolated Lymphadenopathy Associated Virus (LAV)21, from a homosexual patient with prodromal AIDS, and subsequently found the same or similar virus (Immune Deficiency Associated Virus IDAV) in fully developed AIDS patients22
Virus particles resembling Type D retrovimses found in simian AIDS have been demonstrated from Lymph Node Biopsies in some patients23
Although a viral etiology seems highly probable a synergistic interplay of certain factors has been postulated.
Some homosexuals are genetically predisposed, demonstrated by an increased frequency of HLA-DR5 in them, as well as in patients with Kaposi Sarcoma24. Changing sexual practices particularly contacts with multiple anonymous partners increases the risk of repeated and persistent viral infection. Increased use of sexual stimulants like amyl nitrate which is immunesuppressive could play a part. The immunosuppressive effects of intravenously administered sperm in mice suggests that spermatozoa absorbed through abrasions may be imporLat in homosexuals with multiple partners25.
In short AIDS could probably be looked upon as a multifactorial disease resulting from exposure of genetically susceptible individuals to a variety of known and as yet undiscovered environmental agents.


1. Update on acquired immune deficiency syndromeS United States M.M.W.R., 1982; 31:507.
2. Guinan, M.E., Thomas, P.A., Pinsky, P.F., Goodrich, J.T., Selik, R.M., Jaffe, H.W. Haverkos, H.W., Noble, G. and Curran, J.W.Hêterosexual and homosexual patients with the acquired immuno deficiency syndrome; a comparison of surveillance, interview and laboratory data. Ann. Intern. Med., 1984; 100: 213.
3. Soskolne C.L. The acquired immuno deficiency syndrome and female sexual partners of bisexual men. Ann. Intem. Med., 1984; 100: 312.
4. Not, P., Quinn, T.C., Taelman, H., Feinsod, F.M., Minlangu, KB., Wobin, 0., Mbendi, N., Mazebo, P., Ndangi, K., Stevens, W., Kalambayi, K., Mitchell; S., Bridts, C. and McCormick, J.B. Acquired immuno.deficiency syndrome in a Heterosexual population in Zaire. Lancet, 1984; 2: 65.
5. Evatt, B.L., Ramsey, R.B., Lawrence, D.N., Zyla, L.D. and Curran, J.W. The acquired immuno deficiency syndrome in patients with haemophilia. Ann. Intern. Med., 1984; 100: 499.
6. Desforges, J.F. AIDS and preventive treatment in haemophilia. N. Eng. J. Med., 1983; 308:94.
7. Bloom, A.L. Acquired immunodeficiency syndrome and other possible immunological disorders in European haemophiliacs. Lancet, 1984; 1:1452.
8. Deresinski, S.C., Cooney, D.P., Auerbach, D.M., Ammann, A.D., Luft, B. and Goldman, H. AIDS transmission via transfusion therapy. Lancet, 1984; 1:102.
9. Bove, J.R. Transfusion associated AIDS; a cause for concern. N. EngI. J. Med., 1984; 310 : 115.
10. Pitchenik, A.E., Shafran, RD., Glasser, R.M. and Spira, T.J. The acquired immunodeficiency syndrome in the wife of a haemophiiac. Ann. Intern. Med., 100:62.
11. Vilmer, E., Fischer, A., Griscelli, C., Barre-Sinoussi, F Vie, V., Chermann, J.C., Montagnier, L., Rovzioux, C., Brun-vezinet,R. and Rosenbaum, W. Possible transmission of lymphotropic retro viruses from mother to infant with AIDS. Lancet, 1984;2 :229.
12. Pitchenik, A.E., Fischl, MA., Dickinson, G.M., Becker, D.M., Fournier, A.M., O’connell, M.T., Colton, R.M. and Spira, T.J. Opperturistic infections and Kaposis sarcoma among Haitians; + evidence of a new acquired immunodeficiency state. Ann. Intern. Mod.,1983; 98:277.
13. Giraldo, G., Beth, E. and Huang, E.S. Kaposis sarcoma and its relationship to cytomegalovirus (CMNV).III. CMV DNA and CMV early antigens in Kaposi’s sarcoma. Int. J. Cancer, 1980; 26 : 23.
14. Lane, H.C., Masur, H., Edgar, L.C., Whalen, G., Rook, A.H. and Fauci, A.S. Abnormalities of B-cell activation and immuno-regulation in patients with the acquired immunodeficiency syndrome. N. Engl. J. Med., 1983; 309:453.
15. Froebel, K.S., Lowe, G.D.O., Madhok, R. and Forbes, C.D. AIDS and hepatitis B. Lancet, 1984; 1:632.
16. McDonald, M.I., Hamilton, J.D. and Durack, D.T. Hepatitis B surface antigen could harbour the infective agent of AIDS. Lancet, 1983; 882.
17. Essex, M., McLane, M.F., Lee, T.H., Falk, L., Howe, C.W., Mullins, J.I., Cabradilla, C. and Francis, D.P. Antibodies to cell membrane antigen associated with human T-cell leukemia virus in patients with AIDS. Science,1983 ; 220:859.
18. Gelman, E.P., Popovic, M., Blayney, D., Masur, H., Sidhu, G., Stahl, R.E. and Gab, R.C. Proviral DNA of a retrovirus, human T-cell leukemia virus, in two patients with AIDS. Science, 1983; 220:862.
19. Gallo, R.C., Salahuddin, S.Z., Popovic, M., Shearer, G.M. Kaplan, M., Haynes, B.F., Palker, T.J. et al. Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS. Science, 1984; 224 : 500.
20. Behah, W.M. and Burt, AD. HTLV-III Seropositivity in AIDS. Lancet, 1984; 1:1292.
21. Barre-Sinoussi, F., Chermann, J.C., Ray, F., Nugeyre, M.T., Chaxnaret, S., Gruest, J. et al. Isolation of T-lymphotropic retrovirus from a patient at risk for acquired iminunodeficiency syndrome (AIDS). Science, 1983; 220:868.
22. Vilmer, E., Barre-Sinoussi, F., Rouzioux, C.. et al. Isolation of new lymphotropic retrovirus from two sibling with haemóphilia B. and one with AIDS. Lancet, 1984; 2: 753.
23. Maix, PA., Maul, D.H., Osborn, K.G., et al. Simian AIDS; and isolation of type D retrovirus and transmission of the disease. Science, 1984; 223 : 1083.
24. HLA studies in AIDS patients with kaposi Sarcoma. J. Clin. Immunol., 1984;4:242.
25. Hurtenback, U. and Shearer, G.M. Germ cell-induced immune suppression in mice; effects of innoculation of syngeneic spermatozoa on cell-mediated immune response. J. Exp. Med., 1982; 155:1719.

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