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Human immunodeficiency virus (HIV) has been isolated from cervicovaginal secretions from infected women and is thought to be cell associated. To identify which cells harbour viral antigen, we used monoclonal antibodies to OKT4 and a monoclonal antibody directed against HIV p17 core antigen to perform indirect immunofluorescence assays of genital secretions from 17 HIV seropositive and 17 HIV seronegative women with leucorrhoea. OKT4 positive lymphocytes were detected in all tested samples. HIV p17 antigen was detected in the genital fluid lymphocytes in nine out of 14 seropositive subjects from whom lymphocytes were available. No viral antigen was detected in genital fluid lymphocytes of seronegative subjects, nor in any cervicovaginal epithelial cells. This study shows that lymphocytes are the major source of HIV in cervicovaginal secretions of infected women. Conditions that increase the lymphocyte population in the female genital tract, such as sexually transmitted disease (STD), chronic inflammation of the cervix, and menstruation, may facilitate the transmission of HIV during sexual intercourse.

During a 3-month period, 131 cases of herpes zoster were diagnosed in Kigali, Rwanda. There were 46 female and 85 male patients. Mean age was 29 years (range 1–66). An unusually high proportion of patients presented with cranial and sacral nerve localisation of their cutaneous lesions. 55/131 patients (42%) had involvement of more than one derma tome. None of the patients had an underlying condition known to favour herpes zoster. 120/131 (92%) had antibodies to HIV detected by an inununoenzymatic assay (EIA) and indirect immunofluorescence. 92/125 adult patients (74%) had no sign or symptom related to HIV infection other than herpes zoster. This study suggests that herpes zoster in Central Africa is an early and readily detectable manifestation of HIV-induced immunosuppression.

Three commercially available assays for the detection of human immunodeficiency virus (HIV) antibodies-Vironostika enzyme immunoassay (EIA), Wellcozyme competitive EIA, and JLC Allaman indirect immunofluorescence assay--were tested on 300 serum samples from African subjects with and without HIV-related conditions. Two experimental assays both rapid and simple to perform (Biotech dip stick and Cambridge Bioscience latex agglutination) were also evaluated on the same serum samples. The results were compared with those of a commercial Western blot (WB) (immunoblot) assay from Biotech, used as the reference technique. All assays were tested in the laboratory of the AIDS Project in Kigali, Rwanda. Calculated specificity ranged from 90.8% (dip stick) to 98.6% (Vironostika EIA, Wellcozyme competitive EIA, and Cambridge Bioscience latex agglutination). Sensitivity ranged from 95.2% (Cambridge Bioscience latex agglutination) to 98.0% (Vironstika EIA) and JLC indirect immunofluorescence assay). However, the sensitivity of the latex agglutination test improved to 98.6% after the prozone effect was controlled for by serial twofold dilution of latex agglutination-negative, WB-positive samples. In situations with a high prevalence of HIV infection, any one of these tests can be regarded as an alternative to the more expensive, time-consuming, and difficult WB assay.

A prospective study of ophthalmologic findings in 20 African patients with the acquired immunodeficiency syndrome (Group 1) and nine patients with acquired immune deficiency syndrome related complex (Group 2) disclosed that 11 patients in Group 1 and two patients in Group 2 had ocular involvement. Cotton-wool spots, Roth spots, and hemorrhages were frequent features in Group 1. In this series, unlike most others, perivasculitis occurred in five patients whereas cytomegalovirus retinitis and ocular involvement of Kaposi's sarcoma were not observed. These African patients also differed from those previously described in the high proportion of women (11 of 29) and the lack of the usual risk factors (homosexuality, intravenous drug abuse, and hemophilia).

The positive predictive values for HIV seropositivity are compared using WHO and US Centers for Disease Control (CDC) clinical case definitions of acquired immunodeficiency syndrome (AIDS) for cases in Rwanda Africa. It is postulated that the article by Colebunders and co-workers should encourage clinicians and epidemiologists working in Africa to adopt the World Health Organizations provisional clinical case definition for AIDS. Although the predictive value for HIV seropositivity calculated in urban-based adults as measured by the 2 different criteria is comparable (both criteria yield a 93% positive predictive value) this high % is not reached for cases of AIDS diagnosed for rural adults or urban-based children using the WHO criteria. These data confirm the opinion of Colebunders and co-workers that regional variations in the prevalence of HIV infection can interfere with the positive predictive value for HIV seropositivity of this definition. Workers in other countries should test the validity of the WHO criteria in their own settings and evaluate the WHO case definition adapted to pediatric AIDS in Africa.