The acquired immunodeficiency syndrome in Africa.

This review summarizes the unique clinical and epidemiologic features of acquired immunodeficiency syndrome (AIDS) in Africa and identifies problems faced by public health officials in implementing prevention and control strategies. In areas of Central Africa AIDS is spreading relentlessly. Striking had been the increased appearance in Africa of AIDS cases among women and among those with none of the known lifestyle risk factors. Opportunistic infections identified in African AIDS patients include central nervous system cryptococcosis oroesophageal candidiasis central nervous system toxoplasmosis gastrointestinal cryptosporidiosis progressive cutaneous herpes simplex virus infection disseminated cytomegalovirus infection and Mycobacterium tuberculosis. This distribution differs from that seen in the US where Pneumocystis carinii pneumonia is the most common opportunistic infection. A chronic diarrheal-wasting syndrome is a common finding in African AIDS patients. Another major clinical characteristic is the appearance of aggressive disseminated Kaposis sarcoma typically affecting older men. The diagnosis of AIDS in Africa has been hindered however by the lack of a unified case definition due to the inability to diagnose all the opportunistic infections outlined in the World Health Organization protocol and the lack of sufficient laboratory support for the diagnosis and confirmation of human T-lymphotropic virus type III (HTLV-III) infection. Prevention and control activities must take account of the fact that the relative role of modes of transmission differs according to cultural and environmental factors. In addition differences in host susceptibility factors and perhaps genetic differences among the retroviral strains result in differential infection rates throughout the world. Responsible education of the public and cooperation with international health agencies represents the main strategy at present for controlling the spread of AIDS in Africa.