Box Turtle Bulletin

The Daily Agenda for Tuesday, March 19

TODAY IN HISTORY:
Africans Identified As AIDS Risk Group: 1983. As we’ve mentioned before, by the time 1983 came around the panic surrounding the emerging HIV/AIDS crisis had already reached epic proportions, with anti-gay groups and individuals pinning everlasting blame on the gay community. When they had bothered to notice, some would acknowledge that Haitians, drug addicts and hemophiliacs were also at risk for AIDS. But it was the gay community which bore the brunt of the responsibility for the new “plague.”

If ignorance among many Americans was running a fevered pitch, things were very different in Europe, particularly in Belgium and France where doctors had been noticing a strange development for quite some time. For several years, they had been treating wealthy Africans from their former colonies who were suffering from diseases which were remarkably similar to those reported by AIDS patients in America. While AIDS was also showing up in gay communities in Europe, it was these African patients which signaled to European specialists that AIDs was neither a homosexual nor western disease. Finally on March 19, 1983, the rest of the world would learn what they have been noticing with the publication of this brief letter by Dr. Nathan Clumeck of the Université Libre de Bruxelles in the respected journal The Lancet:

Acquired Immune Deficiency Syndrome in Black Africans

SIR,-Acquired immune deficiency syndrome (AIDS) has been described in homosexual or bisexual men, in drug addicts, in haemophiliacs, and in Haitian immigrants. To our knowledge there is no report of AIDS and opportunistic infections in previously healthy Black Africans with no history of homosexuality or drug abuse.

Tables I and II show the clinical and immunological data on five Black patients seen in Brussels and who were from Central Africa (Zaire and Chad). Three of them had been living in Belgium, for between 8 months and 3 years. All were of good socioeconomic status. They presented with prodromes of fever, weight loss, and generalised lymphadenopathy, and extensive investigations did not reveal any neoplasia. Patients A and E died; the three survivors are still ill.

Because the HIV virus had not been discovered yet, there was no test for it. Doctors had to rely on a process of elimination to determine whether the patient really had AIDS:

These patients fulfilled all the criteria of AIDS. Two of them had severe herpes simplex infections and to exclude the possible role of herpes virus in their immune deficiency we did lymphocyte subset analyses in a control group of eight patients with HSV-2 infections. None had OKT4+ deficiency and their OKT4/OKT8 ratios were between 0.99 and 2.52 (mean 1.80), so it is unlikely that HSV-2 alone was responsible for the AIDS in the African patients.

Responses to mitogen stimulation (phytohaemagglutinin, concanavalin A, pokeweed) were well below normal in all cases. In eleven healthy Black Africans reactions to intradermal tuberculin, candida, and streptodornase were >5 mm: all five patients were skin test negative to these antigens.

This preliminary report suggests that Black Africans, immigrants or not, may be another group predisposed to AIDS.

This small letter to the editor would later prove to be an important first indication of the horror that had been stalking the Congo river region for decades. Clumeck and his colleagues would follow up that letter with a larger study a year later published in the New England Journal of Medicine. That study presented detailed data on 23 Africans treated for AIDS as far back as May, 1979. That would be a full two years before the CDC reported on the five gay patients in Los Angeles (See Jun 5). Eighteen of the patients treated in Brussels were from Zaire (now the Democratic Republic of Congo), one from Chad, two from Rwanda, and two from Burundi. By then, ten had died. On further investigation, researchers found that the husband of one patient had died in 1976 in Belgium at the age of 27 from diseases “consistent with AIDS.”

In December 1984, Clumeck and associates published another paper in the Annals of the New York Academy of Sciences expanding their study to 40 patients who had undergone treatment in Belgium. Only two of them were gay male Belgians; the rest were Africans. By then, they had concluded, “It is likely that AIDS is endemic now in Central Africa, and that the cases seen in Belgium represent only the tip of the iceberg.”

[Sources: N. Clumek, F. Mascart-Lemone, J. de Maubeuge, D. Brenez, L. Marcelis. Letter to the editor: “Acquired Immune Deficiency Syndrome in Black Africans.” Lancet 1, no. 8325 (March 19, 1983): 624.

Nathan Clumeck, Jean Sonnet, Henri Taelman, et al. “Acquired immunodeficiency syndrome in African patients.” New England Journal of Medicine 310, no, 8 (February 23, 1984): 492-497.

Nathan Clumeck, Jean Sonnet, Henri Taelman, et al. “Acquired immune deficiency syndrome in Belgium and its relation to Central Africa.” Annals of the New York Academy of Sciences 437 (December 1984): 264-269.]

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