Two black South Africans with AIDS [letter]

A report is presented on 2 cases of fully developed clinical Acquired Immunodeficiency syndrome in 2 adult black women who have never traveled outside the northern Transvaal (South Africa). Patient 1 a 33-year-old Tswana women who had lived her entire life within 50 km of Pretoria presented with severe weight loss diarrhea and fever of 5 months duration followed by dysphagia for 3 months and abdominal pain and cough for 2 weeks. She was emaciated pyrexial and mentally confused. Subphrenic abscesses and pelvic infection were present as well as enlarged lymph nodes in the neck and 1 axilla positive serological tests for syphilis and absolute lymphopenia with progressive anemia. As serological tests for antibody to HIV-1 are done routinely with lymph node biopsy soon after the death of the patient these were found to be positive. Patient 2 a 40-year-old Tswana woman who had lived all her life in the Rustenburg district was transferred from the local hospital for severe diarrhea and weight loss of some months duration and a more recent onset of cough and lymph node enlargement in the groin. She was emaciated and pyrexial. Tests of HIV-1 antibody done as routine at the time of biopsy were positive. ELISAs and Electro-Nucleonics (Vironostika) were the HIV-1 antibody tests used for screening. The 2 cases present informative features which require attention. Both patients female and in the sexually active age group acknowledged neither previous blood transfusions nor use of intravenous drugs. Presumably these are examples of heterosexual spread which has been the most important mode of transmission in black Africa. Contaminated injection needles blood transfusions and mother-to-infant transmissions are secondary but have become important epidemiologic risk factors in some parts of Africa. Patient 1 had been married and had 3 children before her husband died. Subsequently she had 2 children by a common-law husband who deserted her 6 years previous at which time she turned to prostitution. None of her 5 children have HIV-1 antibody or antigenemia which may indicate early antibody-negative infection. The children unlike their mother also were seronegative for syphilis. This presumably indicates that prostitution which began after the birth of the youngest child was the epidemiological risk factor. Patient 2 deserted by the father of her 2 children had cohabited for 4-5 years with a Malawian mine laborer who returned to his country about 2 years ago. Since then she has had 1 sexual relationship of short duration. HIV-1 is prevalent in Malawi and presumably the mothers 2nd consort was the direct source of infection in mother and her 2nd child.