The New York Times - April 17, 1984
David Zimmerman

The doctors fear that an epidemic of the recently recognized syndrome is in progress in Zaire and neighboring Central African nations.

Field estimates, the epidemiologists said, suggest that there may have been 3,500 to 7,000 cases of the disease in Zaire, which has a population about one-eighth as large as the United States. A total of 4,023 AIDS cases have been reported in the United States as of April 9.

In a telephone interview last week, Dr. Kalisa Ruti, a communicable disease specialist and the principal medical adviser to Zaire's Minister of Health, said the most recent report from four hospitals in Kinshasa shows that "there might be 300 cases" thus far in the capital city alone. Three million of Zaire's estimated 30 million people live in Kinshasa.

Three Visiting Experts

Experts who have visited Zaire are Dr. Peter Piot, head of the medical microbiology department at the Belgian Institute of Tropical Medicine in Antwerp; Dr. Thomas C. Quinn of the National Institute of Allergy and Infectious Diseases in Bethesda, Md., and Dr. Joseph B. McCormick of the United States Centers for Disease Control in Atlanta.

In the three weeks the visitors were in Kinshasa, they counted 38 patients with severe AIDS-like illnesses who sought treatment at the Mamo Yemo Hospital, the city's major public hospital. The doctors project that 10 to 20 new AIDS cases may be occurring throughout the country each day, or 3,500 to 7,000 new cases a year.

The three doctors said in recent interviews that their estimates were the best indicators they could find of the magnitude of the AIDS problem in Zaire.

Dr. Ruti said a national surveillance program for AIDS will begin this spring in cooperation with American and Belgian epidemiologists.

The estimate for Zaire is that there are about 250 AIDS cases per million people. In the United States, the incidence has been calculated from case reports and population data at about 16 cases per million people.

Dr. Quinn said there may be seasonal, socioeconomic and geographical differences in the pattern of the disease, as there are in the United States and elsewhere. Many AIDS patients from Ruanda, which borders on Zaire, have Kaposi's sarcoma, a form of cancer, Dr. Ruti said, but in Kinshasa patients tend to have severe opportunistic infections. Both are brought on by the damage caused by AIDS to the body's immune system.

Different Risk Factors

The risk factors for AIDS are different in Zaire than in the United States. About 40 percent of Zairian patients are women, according to Dr. Carl Vermylen, chief of the Belgian Red Cross transfusion center in Louvain. Few of the males admit to being homosexuals, he added.

In the United States over 90 percent of AIDS patients are males, and 70 percent are homosexuals or bisexuals who are believed to spread the disease by sexual contact.

Some specialists in Belgium and Zaire have expressed the fear that the disease may be spreading in Africa through normal sexual contacts between men and women.

Another speculation, raised by a New York University dermatologist, Alvin Friedman-Kien, M.D., at a recent press briefing is that the virus or other agent that causes AIDS may be carried from person to person by the parasite that causes amoebic dysentery. This diarrheal disease, common in Africa and in Haiti, where there are many AIDS cases, has become common among American homosexual men in the last decade.

Viruses Studied

According to Dr. Vermylen, virus studies have failed to detect the HTLV, or human T-cell leukemia virus, that has been speculated to be the cause of AIDS, in Zairian AIDS patients. But a related retrovirus, LAV, or lymphadenopathy virus, may be a better candidate, he said.

The LAV virus was isolated last year by L. Montagnier at the Pasteur Institute in Paris from a patient with pre-AIDS symptoms. Specimens collected in Zaire are being analyzed at Pasteur.

Some American physicians question whether AIDS is a new disease in Zaire or was present all along and is just now being recognized. Belgian doctors, who provided most of Zaire's medical care before independence, are becoming convinced that it is new. The opportunistic infections associated with AIDS are much more common now than they were two decades ago, they say.

In a recent report in the New England Journal of Medicine on 232 African AIDS cases, a team of Belgian doctors wrote: "We are struck by the increasing number of patients who have come from Zaire or Ruanda during the past four years to seek medical care. We believe that AIDS is a new disease that is spreading in Central Africa."

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