REVIEWS OF INFECTIOUS DISEASES • VOL. 9~ NO.6.

NOVEMBER-DECEMBER 1987
© 1987 by The University of Chicago. All rights reserved. 0886-0162/87/0906-0003$02.00

AIDS in the Pre-AIDS Era

David Huminer, Joseph B. Rosenfeld, From the Department of Internal Medicine c: Beilinson
and Silvio D. Pitlik Medical Center, Petah Tiqva; and Sackler School of
Medicine, Tel Aviv University, Tel Aviv, Israel

A search of the medical literature published since 1950 disclosed 19 cases of probable
AIDS reported before the start of the current epidemic. These cases retrospectively met
the Centers for Disease Control's surveillance definition of the syndrome and had a clini-
cal course suggestive of AIDS. The reports originated from North America, Western Eu-
rope, Africa, and the Middle East. The mean age of patients was 37 years, and the ratio
of male to female patients was 1.7:1.Sixteen patients had opportunistic infection(s) with-
out Kaposi's sarcoma. The remainder had disseminated Kaposi's sarcoma. The commonest

Downloaded from http://cid.oxfordjournals.org/ at University of Exeter on July 16, 2015

opportunistic infection was Pneumocystis carinii pneumonia. Twopatients were reported
to be homosexual. Three others had been living in Africa, and one patient was born in
Haiti. In two instances concurrent or subsequent opportunistic infection occurred in family
members. All patients died 1 month to 6 years after the initial manifestation of disease.
In view of the historical data, unrecognized cases of AIDS appear to have occurred spo-
radically in the pre-AIDS era.

The acquired immunodeficiency syndrome (AIDS)
was first described in 1981 [1,2]. The first recognized
cases of this syndrome were seen in the United States
in 1978 [3,4]. Since then more than 20,000 cases have
been identified all over the world [5].
One of the paramount questions regarding the cur-
rent AIDS epidemic is whether the disease occurred
prior to its general recognition. In search of an an-
swer to this question, we have reviewed the medical
literature of the three decades antedating the begin-
ning of this epidemic. We have identified cases that
met the surveillance definition of AIDS and had a
clinical course suggestive of this syndrome. Herein,
we describe the spectrum of disease in patients who
may have had sporadic, unrecognized cases of AIDS
in the pre-AIDS era, and we discuss additional clin-
ical and serologic evidence supporting the occurrence
of AIDS in the past.
Methods
We searched the medical literature from 1950 until
January 1986 for case reports fulfilling the Centers
for Disease Control's (CDC's) surveillance definition
of AIDS [3, 4, 6-9] on the basis of two criteria: first,
the presence of reliably diagnosed disease at least
moderately indicative of underlying cellular immu-
nodeficiency, such as Kaposi's sarcoma in a patient
under 60 years of age, pneumocystis pneumonia, or
other opportunistic infections (table 1);and second,
the absence of known causes of underlying immu-
nodeficiency and of any other reduced resistance
reported to be associated with the disease (im-
munosuppressive therapy, lymphoreticular malig-
nancy).
Such cases were included in the present review if
they could be classified in one of the following two
categories: cases whose descriptions were published
before the first publication on AIDS in May 1981,
or cases whose descriptions were published after 1981
but that were either diagnosed before 1978 or diag-
nosed between 1978 and 1981 but unrecognized as
AIDS at the time of publication. The year of ap-
pearance of Kaposi's sarcoma or the first opportunis-
tic infection was considered the time of the first
manifestation fitting AIDS.
Excluded from the present review were cases lack-
ing sufficient data, cases occurring in children un-
der 5 years of age and in patients more than 60 years
of age, cases in which disease was cured, and cases
of Kaposi's sarcoma in Africa.

Receivedfor publication 22 September 1986and in revisedform

25 March 1987. Results
Please address requests for reprints to Dr. Silvio D. Pitlik,
Department of Internal Medicine C, Beilinson Medical Center, Nineteen cases [10-35] fulfilled both the CDC's sur-
Petah Tiqva 49100, Israel. veillance definition of AIDS and our criteria for in-

1102
AIDS in the Pre-AIDS Era
Table 1. Categoriesof opportunistic infection included
in the Centers for Disease Control's surveillance defini-
tion of AIDS and searched for in the literature review.
Etiology Infection
Protozoal and Intestinal cryptosporidiosis causing diarrhea
helminthic for >1 mo
Pneumocystis carinii pneumonia
Toxoplasmosis causing pneumonia, CNS
infection, or disseminated infection
Strongyloidiasis causing pneumonia, CNS
infection, or disseminated infection
Fungal Candidiasis causing esophagitis
Cryptococcosis causing pulmonary, CNS,
or disseminated infection
Bacterial "Atypical" mycobacteriosis causing dis-
seminated infection
Viral Cytomegaloviral infection of the lungs,
gastrointestinal tract, or CNS
Herpes simplex virus causing chronic muco-
cutaneous infection with ulcers persisting
for >1 mo or pulmonary, gastrointestinal,
or disseminated infection
Progressive multifocal leukoencephalo-
pathy (presumed to be caused by a
papovavirus)
NOTE. Information is adapted from [3, 4J.
elusion in the review. The characteristics of these
cases are summarized in table 2.
No case was recognized as AIDS at the time of
diagnosis, which generally was before this syndrome
had been described. However, the retrospective rec-
ognition of AIDS in seven cases was recently reported
in letters to the editor [25, 26, 30-35]. Two cases
whose descriptions were published after the first re-
port on AIDS [28, 29] were unrecognized as AIDS
at the time of publication.
The first case fitting our criteria occurred in 1952
and was reported in 1953 [10]. The last occurred in
1979 and was reported in 1981 [29]. Twelve of the
patients were male and seven were female (1.7:1 ra-
tio). The mean age was 37 years (range, 12-59 years).
Eight of 19 cases were reported from the United
States. Two reports each came from Canada, the
United Kingdom, and West Germany. Isolated cases
were reported from Sweden, Denmark, Belgium,
Uganda, and Israel. Three case reports described dis-
seminated Kaposi's sarcoma associated with an op-
portunistic or other infection [20, 21, 24]. The rest
of the reports described opportunistic infection(s)
only: Pneumocystis carinii pneumonia (five cases);
1103
cytomegaloviral pneumonia or disseminated cyto-
megaloviral infection, disseminated mycobacterial
infection, and progressive multifocal leukoen-
cephalopathy (three cases each); intestinal cryp-
tosporidiosis (two cases); generalized cryptococco-
sis, disseminated toxoplasmosis, and disseminated
strongyloidiasis (one case each). Three patients had
more than one of the opportunistic infections in-
cluded in the diagnostic criteria for AIDS [12, 27,
29]. In addition to the opportunistic infections listed
in table 2, nine patients had concomitant infectious
diseases such as oral candidiasis [25, 26], dissemi-
Downloaded from http://cid.oxfordjournals.org/ at University of Exeter on July 16, 2015
nated herpes zoster [21], genital and perianal herpes
simplex [26], staphylococcal or pseudomonal sep-
ticemia [10, 15, 25], pneumonia [22, 29], urinary tract
infection [29], nonbacterial meningitis [24], perianal
condylomata acuminata [24], and widespread chla-
mydial infection [20]. Five patients had serologic evi-
dence of previous infection with cytomegalovirus,
Epstein-Barr virus, or herpes simplex virus [20,24,
26,27,29].
Seven patients were reported to have known
predisposing factors for AIDS: two were homosex-
ual men [24, 29]; one was born in Haiti [14]; and
three had been living in Africa [23, 25, 26]. One of
the latter three patients was a surgeon who was heav-
ily exposed to blood and excretions of African pa-
tients [25]. Predisposing factors were not stated in
the rest of the reports.
Six patients had marked lymphopenia [10, 19-21,
25], two had lymphocytosis [13, 27], and eight had
normal lymphocyte counts [11, 12, 15, 16,22,26,28,
29]. Defects in T lymphocyte number and/or func-
tion were reported for four patients [21,25,27,28].
Skin testing with purified protein derivative was
reported to be negative in nine cases [12, 13, 20, 21,
25-29] and positive in three [11, 15, 19]. Four patients
had a high level of serum immunoglobulins [11,25,
26, 28].
In all cases the disease was fatal. Death occurred
from rvl month [16] to 6 years [21] after the first
manifestation of disease, and the mean survival time
was rv1.5 years.
Our review of the literature actually revealed more
cases than are included in table 2. However, most
of these cases had to be excluded because of insuffi-
cient clinical data [36-39], uncertainty about the ex-
istence of an underlying neoplasia [40, 41] or non-
neoplastic hematologic disease [42], difficulty in
ruling out other causes of immunodeficiency [43,
44], or prolonged survival time, which is atypical for
1104 Huminer, Rosenfeld, and Pitlik

Table 2. Unrecognized cases of AIDS in the pre-AIDS era.

Case no., Year of first
year manifestation Kaposi's
[referenceJ Country fitting AIDS Age/sex Opportunistic infection(s) sarcoma

1
1953 [lOJ United States 1952 28/M Cytomegaloviral pneumonia No
1982 [30]*
2, 1960 [11] Canada 1958 36/M Pneumocystis carinii pneumonia No
3
1960 [12] United Kingdom 1959 251M Cytomegaloviral pneumonia, P. carinii No
pneumonia
1983 [31J*
4

Downloaded from http://cid.oxfordjournals.org/ at University of Exeter on July 16, 2015

1961 [13] United States 1959 48/M P. carinii pneumonia No
1961 [14]
1984 [3]*
5, 1968 [15J United Kingdom 1961 121F Disseminated] Mycobacterium avium No
infection
6, 1965 [16] United States 1964 221F P. carinii pneumonia No
7, 1970 [17J United States 1964 46/M Progressive multi focal leuko- No
encephalopathy
8, 1969 [18] Canada 1966 40/M Progressive multifocal leuko- No
encephalopathy
9, 1969 [19] Sweden 1967 23/F Disseminated Mycobacterium kansasii No
infection
10
1973 [20] United States 1968 151M Disseminated
1984 [32]*
11
1977 [21] Israel 1969 59/M Disseminated
1985 [33]*
12, 1972 [22] United States 1969 56/F Progressive multifocal leuko- No
encephalopathy
13, 1976 [23J Uganda 1973 45/M Disseminated strongyloidiasis No
14
1979 [24] West Germany 1976 49/M Disseminated
1983 [34]*
1983 [35J*
15, 1983 [25J* Denmark 1976 47/F P. carinii pneumonia No
16, 1983 [26]* Belgium 1977 34/F Disseminated cryptococcosis No
17, 1980 [27] United States 1978 521F Intestinal cryptosporidiosis, disseminated No
(Hawaii) toxoplasmosis
18, 1982 [28] West Germany 1978 211M Disseminated Mycobacterium fortuitum No
infection
19, 1981 [29J United States 1979 48/M Intestinal cryptosporidiosis, disseminated No
cytomegaloviral infection

* The case was retrospectively recognized as AIDS.

t In all cases the term disseminated refers to involvement of liver, bone marrow, or multiple organs.

AIDS [45-55]. We also excluded cases occurring in
the extremes of age [56-59] because of the possible
existence of either congenital or age-related immu-
nodeficiency. In addition, we did not include cases
of Kaposi's sarcoma occurring in Africa [60, 61] be-
cause it was difficult to differentiate the aggressive,
human immunodeficiency virus (HIV)-related type
of malignancy from the endemic type frequently
found on this continent. These exclusion criteria
prevented the inclusion of doubtful cases and left
AIDS in the Pre-AIDS Era
Table 3. Evidence for the existence of AIDS in the pre-AIDS era.
Clinical
Aggressive Kaposi's sarcoma in young Africans, 1969-1970 [61]
Cases reported to the CDC· occurring in the United States
before 1978 [3]
Probable AIDS in France, 1976-1978 [63]
Cases included in the present report [10- 29]
• CDC = Centers for Disease Control.
only those cases with a high probability of being true
AIDS.
Discussion
The present review suggests that sporadic cases of
AIDS occurred before the beginning of the current
epidemic of this syndrome. Even since the discovery
of HIV, which is the etiologic agent of AIDS [6],
the diagnosis of the syndrome has continued to be
based on clinical criteria [7], e.g., the occurrence of
either life-threatening, opportunistic infection with-
out known underlying immune defects or Kaposi's
sarcoma before age 60 [8]. According to the revised
CDC case definition of AIDS [9], retrospectively
studied cases lacking serologic and immunologic test
results continue to be regarded as AIDS if they satisfy
the clinical criteria. Since all 19 cases included in our
review meet these criteria, they may be regarded as
probable cases of AIDS in the pre-AIDS era.
The high specificity of the CDC case definition
of AIDS was confirmed after the introduction of lab-
oratory tests for the detection of antibody to HIV
[9,62]. It was found that "most persons whose clin-
ical illness fulfills the CDC surveillance definition
for AIDS will have been infected with the virus" [62].
One of the cases reviewed (no. 4) was retrospec-
tively reported to the CDC [3]. Another case of prob-
able AIDS occurring in the United States before 1978
was also reported to the CDC [3], and five similar
cases were retrospectively detected in France [63]. We
have not included these cases in our review because
of insufficient clinical data.
After the discovery of HIV, antibodies to this vi-
rus were detected in stored specimens of serum ob-
tained before 1978 in Africa [64-68], Venezuela [69],
1105
Serologic
Detection of antibodies to human immunodeficiency
virus in stored serum samples from
Africa: Zaire 1959 [64]
Upper Volta 1963 [65]
Zaire 1970 [66]
Uganda 1972-1973 [67]
Zaire 1976 [68]
America: Venezuela 1968 [69J
United States 1971-1972 [70]
Downloaded from http://cid.oxfordjournals.org/ at University of Exeter on July 16, 2015
and the United States [70]. Although some of the
detected antibodies have been proved to be or are
suspected of being false-positive findings [66, 70],
these observations are further evidence for the
sporadic occurrence of AIDS in the past (table 3).
On the other hand, several studies of various
aspects of the syndrome have failed to detect evi-
dence of cases occurring before 1978. These studies
include revisions of cancer registries and autopsy files
in searches for Kaposi's sarcoma in the United States
[71], Denmark [72], and Haiti [73]; data on pentami-
dine use in the United States as an indicator for
P. carinii pneumonia [3, 4]; and data on HIV anti-
body status in sequential samples of plasma from
American [74] and Scottish [75] hemophiliacs.
A critical analysis of the clinical and laboratory
data may call into question our assumption that the
patients included in the present review really suffered
from AIDS. For example, some patients had received
corticosteroid therapy, but only for short periods and
late in the course of their disease (cases no. 1-6, 9,
15, and 19). In one case (no. 13), malnutrition could
not be absolutely excluded as a factor predisposing
to development of the opportunistic infection; on
the other hand, the malnutrition could have resulted
from AIDS. Only one of the patients had his T cell
subsets defined (case no. 18). The immunologic
workup in the majority of cases was incomplete, and
some cases had features that are atypical for but do
not exclude AIDS, such as lymphocytosis (cases no.
4 and 17) and reactive skin tests (cases no. 2, 5, and
9). Despite these difficulties, we believe that at least
some of the 19 cases reviewed were true AIDS.
In one case of a patient with P. carinii pneumo-
nia [16], the same fatal opportunistic infection was
documented almost simultaneously in the patient's
1106
husband, who had acute lymphocytic leukemia as
well. In another instance [26] immune dysfunction
and oral candidiasis were observed in the 3-month-
old daughter of the index case. In view of recent evi-
dence of heterosexual and maternal-neonatal trans-
mission of HIV, these familial cases of opportunis-
tic infection may represent further evidence for the
retrospective diagnosis of AIDS.
The historical data presented in our review lead
us to believe that AIDS is an old disease that has
been unrecognized in the past because of its sporadic
occurrence. The magnitude of the current epidemic
is highlighted by the small number of probable cases
of AIDS reported over a prolonged period in the pre-
AIDS era.
References
1. Centers for Disease Control. Pneumocystis pneumonia - Los
Angeles. MMWR 1981;30:250-2
2. Centers for Disease Control. Kaposi's sarcoma and pneu-
mocystis pneumonia among homosexual men - New York
City and California. MMWR 1981;30:305-8
3. Selik RM, Haverkos HW, Curran JW. Acquired immune defi-
ciency syndrome (AIDS) trends in the United States
1978-1982. Am J Med 1984;76:493-500
4. Jaffe HW, Bregman DJ, Selik RM. Acquired immune defi-
ciency syndrome in the United States: the first 1,000cases.
J Infect Dis 1983;148:339-45
5. Maler H, Assaad F. World Health Organization's Program
on AIDS (opening communication). In: Program and ab-
stracts of the International Conference on AIDS, Paris,
1986
6. Fauci AS, moderator; Masur H, Gelmann EP, Markham PD,
Hahn BH, Lane HC, discussants. The acquired immuno-
deficiency syndrome: an update. Ann Intern Med
1985;102:800-13
7. Masur H, Macher AM. Acquired immune deficiency syn-
drome (AIDS). In: Mandell GL, Douglas RG Jr, Bennett
JE, eds. Principles and practice of infectious diseases. New
York: Wiley, 1985:1670-4
8. Gottlieb MS. Nonneoplastic AIDS syndromes. Semin On-
col 1984;11:40-6
9. Centers for Disease Control. Revision of the case definition
of acquired immunodeficiency syndrome for national
reporting- United States. Ann Intern Med 1985;103:402-3
10. Wyatt JP, Simon T, Trumbull ML, Evans M. Cytomegalic
inclusion pneumonitis in the adult. Am J Clin Pathol
1953;23:353-62
11. Anderson CD, Barrie HJ. Fatal pneumocystis pneumonia in
an adult: report of a case. Am 1 Clin Patholl960;34:365-70
12. Williams G, Stretton TB, Leonard JC. Cytomegalic inclu-
sion disease and Pneumocystis carinii infection in an adult.
Lancet 1960;2:951-5
13. Lyons HA, Vinijchaikul K, Hennigar GR. Pneumocystis
carinii pneumonia unassociated with other disease. Arch
Intern Med 1961;108:929-36
14. Henniger GR, Vinijchaikul K, Roque AL, Lyons HA. Pneu-
Huminet; Rosenfeld, and Pitlik
mocystis carinii pneumonia in an adult: report of a case.
Am 1 Clin Pathol 1961;35:353-64
15. Schonell ME, Crofton JW, Stuart AE, Wallace A. Dissemi-
nated infection with Mycobacterium avium. I. Clinical-
features, treatment and pathology. Tubercle 1968;49:12-30
16. Watanabe 1M, Chinchinian H, Weitz C, Mcilvanie SK. Pneu-
mocystis carinii pneumonia in a family. JAMA 1965;193:
685-6
17. Fermaglich J, Hardman JM, Earle KM. Spontaneous progres-
sive multifocal leukoencephalopathy. Neurology 1970;20:
479-84
18. Bolton CF, Rozdilsky B. Primary progressive multifocal leu-
koencephalopathy: a case report. Neurology 1971;21:72-7
19. Hagmar B, Kutti J, Lundin P, Norlin M, Weinfeld A, Wahlen
P. Disseminated infection caused by Mycobacterium kan-
Downloaded from http://cid.oxfordjournals.org/ at University of Exeter on July 16, 2015
sasii: report of a case and brief review of the literature.
Acta Med Scand 1969;186:93-9
20. Elvin-Lewis M, Witte M, Witte C, Cole W, Davis J. Systemic
chlamydial infection associated with generalized lym-
phedema and lymphangiosarcoma. Lymphology 1973;6:
113-21
21. Flatau E, Resnitzky P, Grishkan A, Levy E. Malignant evo-
lution of Kaposi's sarcoma with impaired cellular immu-
nity. Harefuah 1977;93:242-4
22. Faris AA, Martinez AJ. Primary progressive multifocal leu-
koencephalopathy: a central nervous system disease caused
by a slow virus. Arch Neurol 1972;27:357-60
23. Owor R, Wamukota WM. A fatal case of strongyloidiasis
with Strongyloides larvae in the meninges. Trans R Soc
Trop Med Hyg 1976;70:497-9
24. Sterry W, Konrads A, Laaser U. Kaposi-Sarkom und
aplastische panzytopenie: Gleichzeitiges auftreten bei ei-
nem patienten. Hautarzt 1979;30:540-3
25. Bygbjerg IC. AIDS in a Danish surgeon (Zaire 1976) [letter].
Lancet 1983;1:925
26. Vandepitte J, Verwilghen R, Zachee P. AIDS and cryptococ-
cosis (Zaire 1977) [letter]. Lancet 1983;1:925-6
27. Stemmerman GN, Hayashi T, Glober GA, Oishi N, Frankel
RI. Cryptosporidiosis: report of a fatal case complicated
by disseminated toxoplasmosis. Am J Med 1980;69:637-42
28. Billtmann BD, Flad HD, Kaiserling E, Miiller-Hermelink HK,
Kratzsch G, Galle J, Schachenmayr W, Heimpel H, Wig-
ger HJ, Haferkamp O. Disseminated mycobacterial
histiocytosis due to M. fortuitum associated with helper
T-Iymphocyte immune deficiency. Virchows Arch 1982;395:
217-25
29. Weinstein L, Edelstein SM, Madara JL, Falchuk KR, McMa-
nus BM, Trier 1S. Intestinal cryptosporidiosis complicated
by disseminated cytomegalovirus infection. Gastroenterol-
ogy 1981;81:584-91
30. Nichols PW. Opportunistic infections and Kaposi's sarcoma
in homosexual men [letter]. N Eng} J Med 1982;306:934-5
31. Williams G, Stretton TB, Leonard JC. AIDS in 1959? [let-
ter] Lancet 1983;2:1136
32. Witte MH, Witte CL, Minnich LL, Finley PR, Drake WL
Jr. AIDS in 1968 [letter]. lAMA 1984;251:2657
33. Huminer D. Was a case of AIDS reported in "Harefuah" be-
fore the first publication on the syndrome in the USA?
[letter] Harefuah 1985;109:424-5
34. Konrads A, Sterry W. AIDS 1976in Koln? [letter] Dtsch Med
Wochenschr 1983;108:1336
AIDS in the Pre-AIDS Era
35. Sterry W, Marmor M, Konrads A, SteiglederGK. Kaposi's
sarcoma,aplastic pancytopeniaand multipleinfectionsin
a homosexual (Cologne, 1976) [letter]. Lancet1983;1:924-5
36. Riganti M, Bhamarapravati N. Double viral infection in an
adult: report of a case of disseminatedherpes simplexin-
fection and cytomegalic inclusion disease. Am J ClinPathol
1961;35:441-6
37. Reynolds WA, Winkelmann RK,SouleEH. Kaposi's sarcoma:
a clinicopathologic study with particular referenceto its
relationship to the reticuloendothelial system. Medicine
1965;44:419-43
38. Yanagisawa N, ToyokuraY,Shiraki H. Double encephalitis
with herpessimplex virusand cytomegalovirus in an adult.
Acta Neuropathol (Bert) 1975;33:153-64
39. Mathews T, Wisotzkey H, Moossy J. Multiple central ner-
vous systeminfections in progressive multifocalleukoen-
cephalopathy. Neurology 1976;26:9-14
40. DibellaNJ, Buchanan BD,Koontz CH. Disseminatedatyp-
ical tuberculosis antedating the clinical onset of neopla-
sia. Cancer 1977;40:1276-9
41. Heenan PJ, DowkinsRL. Cryptococcosis and multiplesqua-
mous cell tumors associated with a T-cell defect. Cancer
1981;47:291-5
42. Zamorano J Jr, Tompsett R. Disseminated atypicalmycobac-
terial infection and pancytopenia. Arch Intern Med
1968;121:424-7
43. Joseph TJ, Vogt PJ. Disseminated herpeswith hepatoadrenal
necrosis in an adult. Am J Med 1974;56:735-9
44. Fisher ER, Davis E. Cytomegalic-inclusion disease in the
adult. N Engl J Med 1958;258:1036-40
45. Perham TOM, Caul EO, Clarke SKR, Gibson AGF. Cyto-
megalovirus meningoencephalitis [letter]. Br Med J 1971;
2:50
46. Weiner LP, Herndon RM, Narayan 0, Johnson RT, Shah K,
RubinsteinLJ, PreziosiTJ, ConleyFK. Isolation of virus
related to SV40 from patients with progressive multifocal
leukoencephalopathy. N Engl J Med 1972;286:385-90
47. Lakshminarayan S, Sahn S. Disseminated infection caused
by Mycobacterium avium: report of a casewith associated
leukopenia. Am Rev Respir Dis 1973;108:123-6
48. Chin W,Magoffin R, Frierson JG, LennetteEH. Cytomega-
lovirusinfection:a casewith meningoencephalitis. JAMA
1973;225:740-1
49. Simon HB, Guerry D, Breslow A, Kirkpatrick CH. Oppor-
tunistic pathogens in the immunologicallyhyperrespon-
sivehost: Pneumocystis carinii infection in a patient with
allergic bronchopulmonaryaspergillosis. Am J Med 1973;
55:856-64
50. RoyleG, Fraser-MoodieA, Jones MW.Hyperinfectionwith
Strongyloides stercoralis in Great Britain. Br J Surg
1974;61:498-500
51. Gentry RH, Farrar WE Jr, Mahvi TA, Prevost AE, Gionis
TA. Simultaneousinfection of the central nervoussystem
with Cryptococcus neoformans and Mycobacterium in-
tracellulare. South Med J 1977;70:865-6
52. PhillipsCA, FanningWL, Gump DW, PhillipsCF. Cytomeg-
alovirus encephalitis in immunologically normal adults:
successful treatment with ridarabine. JAMA 1977;
238:2299-300
53. DepewWT, Prentice RSA, Beck IT, Blakeman PM. Herpes
simplexulcerativeesophagitis in a healthy subject. Am J
1107
Gastroenterol 1977;68:381-5
54. OwensbyLC,Stammer JL. Esophagitis associatedwith her-
pes simplexinfection in an immunocompetent host. Gas-
troenterology 1978;74:1305-6
55. Bone M, Stableforth D. Miliary infection due to Mycobac-
terium avlum-intracellulare. Thbercle 1981;62:211-3
56. Koenig MG,Collins RD,Heyssel RM. Disseminated mycobac-
teriosis caused by Battey type mycobacteria. Ann Intern
Med 1966;64:145-54
57. Huneycutt HC, Anderson WR, Hendry WS. Pneumocystis
carinii pneumonia: case studieswith electronmicroscopy.
Am J Clin Pathoi 1964;41:411-8
58. KouvalainenK, Hjelt L, Wasz-HockertO. Marked elevation
of beta-2M globulin in a patient with interstitial plasma
cell pneumonia. Acta Paediatr Scand 1964;53:465-9
Downloaded from http://cid.oxfordjournals.org/ at University of Exeter on July 16, 2015
59. Smith SB,SchwartzmanM, MenciaLF, BlumEB, Krogstad
0, Nitzkin J, Healy GR. Fatal disseminatedstrongyloidi-
asis presenting as acute abdominal distress in an urban
child. J Pediatr 1977;91:607-9
60. Gelfand M. Kaposi's haemangiosarcoma of the heart. Br
Heart J 1957;19:290-2
61. Taylor JF, Tempelton AC, Vogel CL, Ziegler JL, Kyalwazi
SK. Kaposi's sarcoma in Uganda: a clinico-pathological
study. Int J Cancer 1971;8:122-35
62. Leads from the MMWR. Classification system for human
T-Iymphotropic virus type-Ill/lymphadenopathy-asso-
ciated virus infections. JAMA 1986;256:20-5
63. Brunet JB, BouvetE, Leibowitch J, Chaperon J, MayaudC,
GluckmanJC, Picard 0, Kernbaum S, Revuz J, Klatzmann
D, Rozenbaum W, Lachiver 0, Villalonga J, Wesselberg
C. Acquired immunodeficiency syndrome in France [let-
ter]. Lancet 1983;1:700-1
64. Nahmias AJ, Weiss J, Yao X, LeeF, KodsiR, Schanfield M,
MatthewsT, Bolognesi 0, Durack D, Motulsky A, Kanki
P, EssexM. Evidencefor human infection with an HTLV
Ill/LAV-like virus in central Africa, 1959 [letter]. Lancet
1986;1:1279-80
65. EpsteinJS, Moffitt AL, MaynerRE. Antibodies reactive with
HTLV-III found in freezer-banked sera from children in
WestAfrica. [abstract no. 217]. In: Program and abstracts
of the 25th Interscience Conference on Antimicrobial
Agents and Chemotherapy. Washington, DC: American
Society for Microbiology, 1985:130
66. Desmyter J, Gouban P, Chamaret S, Montagnier L. Anti-
LAVlHTLV-III in Kinshasa mothersin 1970 and 1980 (com-
munication 110:S17g). In: Program and abstracts of the
International Conference on AIDS, Paris, 1986:106
67. Saxinger WC,Levine PH, DeanAG,deThe G, Lange-Wantzin
G, Moghissi J, Laurent F, Hoh M, Sarngadharan MG,
Gallo RC. Evidencefor exposureto HTLV-III in Uganda
before 1973. Science 1985;227:1036-8
68. Forthal ON, Getchell JP, Mann J. Antibody to human
'l-lymphotropic virus type III/lymphadenopathy-associ-
ated virus(HTLV-Ill/LAV) in seracollected in 1976, equa-
tor regionZaire (poster 370).In: Abstracts of the Interna-
tional Conference on AIDS, Paris, 1986:129
69. Rodriguez L, Dewhurst S, Sinangil F, Merino F, Godoy G,
Volsky OJ. Antibodies to HTLV-IIl/LAV among aborigi-
nal Amazonian Indians in Venezuela. Lancet 1985;2:
1098-100
70. Moore JD, Cone EJ, Alexander SS Jr. HTLV-III seroposi-
1108
tivity in 1971-1972: parenteral drug abusers-a case of false
positives or evidence of viral exposure? [letter] N Engl J
Med 1986;314:1387-8
71. Gilkey FW. Opportunistic infections and Kaposi's sarcoma
in homosexual men [letter]. N Engl J Med 1982;306:934
72. Jensen OM, Mouridsen HT, Petersen NS, Jensen KH, Thom-
sen K, Ulrich K. Kaposi's sarcoma in homosexual men:
is it a new disease? [letter] Lancet 1982;1:1027
73. Leonidas J-R, Hyppolite N. Haiti and the acquired immu-
Huminet; Rosenfeld. and Pitlik
nodeficiency syndrome. Ann Intern Med 1983;98:1020-1
74. Evatt BL, Gomperts ED, McDougal JS, Ramsey RB. Coin-
cidental appearance of LAVlHTLV-III antibodies in
hemophiliacs and the onset of the AIDS epidemic. N Engl
J Med 1985;312:483-6
75. Madhok R, Melbye M, Lowe GOO, Forbes CD, Froebil KS,
Bodner AJ, Biggar RJ. HTLV-III antibody in sequential
plasma samples from haernophiliacs 1974-84 [letter]. lan-
cet 1985;1:524-5
Downloaded from http://cid.oxfordjournals.org/ at University of Exeter on July 16, 2015