Skip to main content
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1987 Dec;147(6):694–701.

Global Epidemiology

C Fordham Von Reyn, Jonathan M Mann
PMCID: PMC1025987  PMID: 3433752

Abstract

A total of 62,811 cases of the acquired immunodeficiency syndrome (AIDS) have been reported to the World Health Organization from throughout the world. Extensive epidemiologic studies have shown that human immunodeficiency virus (HIV) infections are transmitted by three routes: sexual, parenteral and perinatal. Three geographic patterns of transmission have been defined. In pattern I, transmission occurs predominantly among homosexual and bisexual men and urban intravenous drug abusers; transmission via blood products has been controlled; the male:female sex ratio is 10:1 or more; population HIV seroprevalence is low, and perinatal transmission is uncommon (for instance, United States, western Europe). In pattern II, transmission is predominantly heterosexual and perinatal; transmission via blood products exists but is being reduced; unsterile needles and other skin-piercing instruments cause some parenteral transmission (magnitude not known); the male:female sex ratio is 1:1, and population seroprevalence often exceeds 1% (central Africa, Haiti). In pattern III, AIDS cases are just being documented and are generally due to sexual exposure abroad or imported blood products (Middle East, Asia).

Full text

PDF
694

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barré-Sinoussi F., Chermann J. C., Rey F., Nugeyre M. T., Chamaret S., Gruest J., Dauguet C., Axler-Blin C., Vézinet-Brun F., Rouzioux C. Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science. 1983 May 20;220(4599):868–871. doi: 10.1126/science.6189183. [DOI] [PubMed] [Google Scholar]
  2. Biggar R. J., Gigase P. L., Melbye M., Kestens L., Sarin P. S., Bodner A. J., Demedts P., Stevens W. J., Paluku L., Delacollette C. ELISA HTLV retrovirus antibody reactivity associated with malaria and immune complexes in healthy Africans. Lancet. 1985 Sep 7;2(8454):520–523. doi: 10.1016/s0140-6736(85)90461-1. [DOI] [PubMed] [Google Scholar]
  3. Biggar R. J. Possible nonspecific association between malaria and HTLV-III/LAV. N Engl J Med. 1986 Aug 14;315(7):457–458. doi: 10.1056/NEJM198608143150714. [DOI] [PubMed] [Google Scholar]
  4. Browning M. J. AIDS in Scotland: an update. Scott Med J. 1987 Feb;32(1):4–5. doi: 10.1177/003693308703200102. [DOI] [PubMed] [Google Scholar]
  5. Brunet J. B., Bouvet E., Leibowitch J., Chaperon J., Mayaud C., Gluckman J. C., Picard O., Kernbaum S., Revuz J., Klatzmann D. Acquired immunodeficiency syndrome in France. Lancet. 1983 Mar 26;1(8326 Pt 1):700–701. doi: 10.1016/s0140-6736(83)91985-2. [DOI] [PubMed] [Google Scholar]
  6. Castro B. G., Fernandez J. C., de Castilho E. A., Pereira H. G., Pereira M. S., Cruz F. O. Human immunodeficiency virus infection in Brazil. JAMA. 1987 May 15;257(19):2592–2593. [PubMed] [Google Scholar]
  7. Clavel F., Mansinho K., Chamaret S., Guetard D., Favier V., Nina J., Santos-Ferreira M. O., Champalimaud J. L., Montagnier L. Human immunodeficiency virus type 2 infection associated with AIDS in West Africa. N Engl J Med. 1987 May 7;316(19):1180–1185. doi: 10.1056/NEJM198705073161903. [DOI] [PubMed] [Google Scholar]
  8. Clumeck N., Mascart-Lemone F., de Maubeuge J., Brenez D., Marcelis L. Acquired immune deficiency syndrome in Black Africans. Lancet. 1983 Mar 19;1(8325):642–642. doi: 10.1016/s0140-6736(83)91808-1. [DOI] [PubMed] [Google Scholar]
  9. Clumeck N., Robert-Guroff M., Van de Perre P., Jennings A., Sibomana J., Demol P., Cran S., Gallo R. C. Seroepidemiological studies of HTLV-III antibody prevalence among selected groups of heterosexual Africans. JAMA. 1985 Nov 8;254(18):2599–2602. [PubMed] [Google Scholar]
  10. Clumeck N., Sonnet J., Taelman H., Mascart-Lemone F., De Bruyere M., Vandeperre P., Dasnoy J., Marcelis L., Lamy M., Jonas C. Acquired immunodeficiency syndrome in African patients. N Engl J Med. 1984 Feb 23;310(8):492–497. doi: 10.1056/NEJM198402233100804. [DOI] [PubMed] [Google Scholar]
  11. Colebunders R., Mann J. M., Francis H., Bila K., Izaley L., Kakonde N., Kabasele K., Ifoto L., Nzilambi N., Quinn T. C. Evaluation of a clinical case-definition of acquired immunodeficiency syndrome in Africa. Lancet. 1987 Feb 28;1(8531):492–494. doi: 10.1016/s0140-6736(87)92099-x. [DOI] [PubMed] [Google Scholar]
  12. Cooper D. A., Imrie A. A., Penny R. Antibody response to human immunodeficiency virus after primary infection. J Infect Dis. 1987 Jun;155(6):1113–1118. doi: 10.1093/infdis/155.6.1113. [DOI] [PubMed] [Google Scholar]
  13. Denis F., Barin F., Gershy-Damet G., Rey J. L., Lhuillier M., Mounier M., Leonard G., Sangare A., Goudeau A., M'Boup S. Prevalence of human T-lymphotropic retroviruses type III (HIV) and type IV in Ivory Coast. Lancet. 1987 Feb 21;1(8530):408–411. doi: 10.1016/s0140-6736(87)90118-8. [DOI] [PubMed] [Google Scholar]
  14. Fischl M. A., Dickinson G. M., Scott G. B., Klimas N., Fletcher M. A., Parks W. Evaluation of heterosexual partners, children, and household contacts of adults with AIDS. JAMA. 1987 Feb 6;257(5):640–644. [PubMed] [Google Scholar]
  15. Follett E. A., Wallace L. A., McCruden E. A. HIV and HBV infection in drug abusers in Glasgow. Lancet. 1987 Apr 18;1(8538):920–920. doi: 10.1016/s0140-6736(87)92893-5. [DOI] [PubMed] [Google Scholar]
  16. Francis D. P., Chin J. The prevention of acquired immunodeficiency syndrome in the United States. An objective strategy for medicine, public health, business, and the community. JAMA. 1987 Mar 13;257(10):1357–1366. [PubMed] [Google Scholar]
  17. Fraser A. G., Henley J. W., Ellis-Pegler R. B., Benjamin C. S., Childs W. J., Harvey V. J. The acquired immunodeficiency syndrome in Auckland in 1985. N Z Med J. 1986 Jul 9;99(805):485–488. [PubMed] [Google Scholar]
  18. Fujikawa L. S., Salahuddin S. Z., Palestine A. G., Masur H., Nussenblatt R. B., Gallo R. C. Isolation of human T-lymphotropic virus type III from the tears of a patient with the acquired immunodeficiency syndrome. Lancet. 1985 Sep 7;2(8454):529–530. doi: 10.1016/s0140-6736(85)90464-7. [DOI] [PubMed] [Google Scholar]
  19. Gallo R. C., Salahuddin S. Z., Popovic M., Shearer G. M., Kaplan M., Haynes B. F., Palker T. J., Redfield R., Oleske J., Safai B. Frequent detection and isolation of cytopathic retroviruses (HTLV-III) from patients with AIDS and at risk for AIDS. Science. 1984 May 4;224(4648):500–503. doi: 10.1126/science.6200936. [DOI] [PubMed] [Google Scholar]
  20. Gerberding J. L., Bryant-LeBlanc C. E., Nelson K., Moss A. R., Osmond D., Chambers H. F., Carlson J. R., Drew W. L., Levy J. A., Sande M. A. Risk of transmitting the human immunodeficiency virus, cytomegalovirus, and hepatitis B virus to health care workers exposed to patients with AIDS and AIDS-related conditions. J Infect Dis. 1987 Jul;156(1):1–8. doi: 10.1093/infdis/156.1.1. [DOI] [PubMed] [Google Scholar]
  21. HIV infection in the Dominican Republic. JAMA. 1987 Jul 3;258(1):46–47. [PubMed] [Google Scholar]
  22. Henderson D. K., Saah A. J., Zak B. J., Kaslow R. A., Lane H. C., Folks T., Blackwelder W. C., Schmitt J., LaCamera D. J., Masur H. Risk of nosocomial infection with human T-cell lymphotropic virus type III/lymphadenopathy-associated virus in a large cohort of intensively exposed health care workers. Ann Intern Med. 1986 May;104(5):644–647. doi: 10.7326/0003-4819-104-5-644. [DOI] [PubMed] [Google Scholar]
  23. Ho D. D., Byington R. E., Schooley R. T., Flynn T., Rota T. R., Hirsch M. S. Infrequency of isolation of HTLV-III virus from saliva in AIDS. N Engl J Med. 1985 Dec 19;313(25):1606–1606. doi: 10.1056/NEJM198512193132512. [DOI] [PubMed] [Google Scholar]
  24. James J. J., Morgenstern M. A., Hatten J. A. HTLV-III/LAV-antibody-positive soldiers in Berlin. N Engl J Med. 1986 Jan 2;314(1):55–56. doi: 10.1056/NEJM198601023140112. [DOI] [PubMed] [Google Scholar]
  25. Jovaisas E., Koch M. A., Schäfer A., Stauber M., Löwenthal D. LAV/HTLV-III in 20-week fetus. Lancet. 1985 Nov 16;2(8464):1129–1129. doi: 10.1016/s0140-6736(85)90720-2. [DOI] [PubMed] [Google Scholar]
  26. Kanki P. J., M'Boup S., Ricard D., Barin F., Denis F., Boye C., Sangare L., Travers K., Albaum M., Marlink R. Human T-lymphotropic virus type 4 and the human immunodeficiency virus in West Africa. Science. 1987 May 15;236(4803):827–831. doi: 10.1126/science.3033826. [DOI] [PubMed] [Google Scholar]
  27. Koenig R. E., Pittaluga J., Bogart M., Castro M., Nunez F., Vilorio I., Delvillar L., Calzada M., Levy J. A. Prevalence of antibodies to the human immunodeficiency virus in Dominicans and Haitians in the Dominican Republic. JAMA. 1987 Feb 6;257(5):631–634. [PubMed] [Google Scholar]
  28. Kreiss J. K., Kitchen L. W., Prince H. E., Kasper C. K., Goldstein A. L., Naylor P. H., Preble O., Stewart J. A., Essex M. Human T cell leukemia virus type III antibody, lymphadenopathy, and acquired immune deficiency syndrome in hemophiliac subjects. Results of a prospective study. Am J Med. 1986 Mar;80(3):345–350. doi: 10.1016/0002-9343(86)90704-7. [DOI] [PubMed] [Google Scholar]
  29. Kreiss J. K., Koech D., Plummer F. A., Holmes K. K., Lightfoote M., Piot P., Ronald A. R., Ndinya-Achola J. O., D'Costa L. J., Roberts P. AIDS virus infection in Nairobi prostitutes. Spread of the epidemic to East Africa. N Engl J Med. 1986 Feb 13;314(7):414–418. doi: 10.1056/NEJM198602133140704. [DOI] [PubMed] [Google Scholar]
  30. Kurimura T., Kawatani T., Hattori N., Tsuchie H. Prevalence and transmission of human immunodeficiency virus in Japan. AIDS Res. 1986 Dec;2 (Suppl 1):S163–S166. [PubMed] [Google Scholar]
  31. Lapointe N., Michaud J., Pekovic D., Chausseau J. P., Dupuy J. M. Transplacental transmission of HTLV-III virus. N Engl J Med. 1985 May 16;312(20):1325–1326. doi: 10.1056/NEJM198505163122012. [DOI] [PubMed] [Google Scholar]
  32. Lifson A. R., Castro K. G., McCray E., Jaffe H. W. National surveillance of AIDS in health care workers. JAMA. 1986 Dec 19;256(23):3231–3234. [PubMed] [Google Scholar]
  33. Mann J. M., Francis H., Davachi F., Baudoux P., Quinn T. C., Nzilambi N., Bosenge N., Colebunders R. L., Kabote N., Piot P. Human immunodeficiency virus seroprevalence in pediatric patients 2 to 14 years of age at Mama Yemo Hospital, Kinshasa, Zaire. Pediatrics. 1986 Oct;78(4):673–677. [PubMed] [Google Scholar]
  34. Mann J. M., Francis H., Davachi F., Baudoux P., Quinn T. C., Nzilambi N., Bosenge N., Colebunders R. L., Piot P., Kabote N. Risk factors for human immunodeficiency virus seropositivity among children 1-24 months old in Kinshasa, Zaire. Lancet. 1986 Sep 20;2(8508):654–657. doi: 10.1016/s0140-6736(86)90167-4. [DOI] [PubMed] [Google Scholar]
  35. Mann J. M., Francis H., Quinn T. C., Bila K., Asila P. K., Bosenge N., Nzilambi N., Jansegers L., Piot P., Ruti K. HIV seroprevalence among hospital workers in Kinshasa, Zaire. Lack of association with occupational exposure. JAMA. 1986 Dec 12;256(22):3099–3102. [PubMed] [Google Scholar]
  36. Marmor M., Weiss L. R., Lyden M., Weiss S. H., Saxinger W. C., Spira T. J., Feorino P. M. Possible female-to-female transmission of human immunodeficiency virus. Ann Intern Med. 1986 Dec;105(6):969–969. doi: 10.7326/0003-4819-105-6-969_1. [DOI] [PubMed] [Google Scholar]
  37. McCray E. Occupational risk of the acquired immunodeficiency syndrome among health care workers. N Engl J Med. 1986 Apr 24;314(17):1127–1132. doi: 10.1056/NEJM198604243141729. [DOI] [PubMed] [Google Scholar]
  38. McGrady G. A., Jason J. M., Evatt B. L. The course of the epidemic of acquired immunodeficiency syndrome in the United States hemophilia population. Am J Epidemiol. 1987 Jul;126(1):25–30. doi: 10.1093/oxfordjournals.aje.a114657. [DOI] [PubMed] [Google Scholar]
  39. Melbye M., Njelesani E. K., Bayley A., Mukelabai K., Manuwele J. K., Bowa F. J., Clayden S. A., Levin A., Blattner W. A., Weiss R. A. Evidence for heterosexual transmission and clinical manifestations of human immunodeficiency virus infection and related conditions in Lusaka, Zambia. Lancet. 1986 Nov 15;2(8516):1113–1115. doi: 10.1016/s0140-6736(86)90527-1. [DOI] [PubMed] [Google Scholar]
  40. Michaelis B. A., Levy J. A. Recovery of human immunodeficiency virus from serum. JAMA. 1987 Mar 13;257(10):1327–1327. doi: 10.1001/jama.1987.03390100065011. [DOI] [PubMed] [Google Scholar]
  41. Mok J. Q., Giaquinto C., De Rossi A., Grosch-Wörner I., Ades A. E., Peckham C. S. Infants born to mothers seropositive for human immunodeficiency virus. Preliminary findings from a multicentre European study. Lancet. 1987 May 23;1(8543):1164–1168. doi: 10.1016/s0140-6736(87)92142-8. [DOI] [PubMed] [Google Scholar]
  42. Nahmias A. J., Weiss J., Yao X., Lee F., Kodsi R., Schanfield M., Matthews T., Bolognesi D., Durack D., Motulsky A. Evidence for human infection with an HTLV III/LAV-like virus in Central Africa, 1959. Lancet. 1986 May 31;1(8492):1279–1280. doi: 10.1016/s0140-6736(86)91422-4. [DOI] [PubMed] [Google Scholar]
  43. Napoli V. M., McGowan J. E., Jr How much blood is in a needlestick? J Infect Dis. 1987 Apr;155(4):828–828. doi: 10.1093/infdis/155.4.828. [DOI] [PubMed] [Google Scholar]
  44. Padian N. S. Heterosexual transmission of acquired immunodeficiency syndrome: international perspectives and national projections. Rev Infect Dis. 1987 Sep-Oct;9(5):947–960. doi: 10.1093/clinids/9.5.947. [DOI] [PubMed] [Google Scholar]
  45. Pape J. W., Liautaud B., Thomas F., Mathurin J. R., St Amand M. M., Boncy M., Pean V., Pamphile M., Laroche A. C., Dehovitz J. The acquired immunodeficiency syndrome in Haiti. Ann Intern Med. 1985 Nov;103(5):674–678. doi: 10.7326/0003-4819-103-5-674. [DOI] [PubMed] [Google Scholar]
  46. Petricciani J. C. Licensed tests for antibody to human T-lymphotropic virus type III. Sensitivity and specificity. Ann Intern Med. 1985 Nov;103(5):726–729. doi: 10.7326/0003-4819-103-5-726. [DOI] [PubMed] [Google Scholar]
  47. Piot P., Plummer F. A., Rey M. A., Ngugi E. N., Rouzioux C., Ndinya-Achola J. O., Veracauteren G., D'Costa L. J., Laga M., Nsanze H. Retrospective seroepidemiology of AIDS virus infection in Nairobi populations. J Infect Dis. 1987 Jun;155(6):1108–1112. doi: 10.1093/infdis/155.6.1108. [DOI] [PubMed] [Google Scholar]
  48. Piot P., Quinn T. C., Taelman H., Feinsod F. M., Minlangu K. B., Wobin O., Mbendi N., Mazebo P., Ndangi K., Stevens W. Acquired immunodeficiency syndrome in a heterosexual population in Zaire. Lancet. 1984 Jul 14;2(8394):65–69. doi: 10.1016/s0140-6736(84)90241-1. [DOI] [PubMed] [Google Scholar]
  49. Quinn T. C., Mann J. M., Curran J. W., Piot P. AIDS in Africa: an epidemiologic paradigm. Science. 1986 Nov 21;234(4779):955–963. doi: 10.1126/science.3022379. [DOI] [PubMed] [Google Scholar]
  50. Quinn T. C., Piot P., McCormick J. B., Feinsod F. M., Taelman H., Kapita B., Stevens W., Fauci A. S. Serologic and immunologic studies in patients with AIDS in North America and Africa. The potential role of infectious agents as cofactors in human immunodeficiency virus infection. JAMA. 1987 May 15;257(19):2617–2621. [PubMed] [Google Scholar]
  51. Rodriquez L., Dewhurst S., Sinangil F., Merino F., Godoy G., Volsky D. J. Antibodies to HTLV-III/LAV among aboriginal Amazonian Indians in Venezuela. Lancet. 1985 Nov 16;2(8464):1098–1100. doi: 10.1016/s0140-6736(85)90688-9. [DOI] [PubMed] [Google Scholar]
  52. Ross M. W., Cameron A. S. Epidemiology of AIDS retrovirus in South Australia. Med J Aust. 1986 May 26;144(11):614–615. doi: 10.5694/j.1326-5377.1986.tb112332.x. [DOI] [PubMed] [Google Scholar]
  53. Serwadda D., Mugerwa R. D., Sewankambo N. K., Lwegaba A., Carswell J. W., Kirya G. B., Bayley A. C., Downing R. G., Tedder R. S., Clayden S. A. Slim disease: a new disease in Uganda and its association with HTLV-III infection. Lancet. 1985 Oct 19;2(8460):849–852. doi: 10.1016/S0140-6736(85)90122-9. [DOI] [PubMed] [Google Scholar]
  54. Sirianni M. C., Rossi P., Moroni M., Romagnani S., Lazzarin A., Carbonari M., Scarpati B., Mariani M., Manconi P. E., Del Giacco G. S. Demonstration of antibodies to human T-lymphotropic retrovirus type III in lymphoadenopathy syndrome patients and in individuals at risk for acquired immune deficiency syndrome (AIDS) in Italy. Am J Epidemiol. 1986 Feb;123(2):308–315. doi: 10.1093/oxfordjournals.aje.a114239. [DOI] [PubMed] [Google Scholar]
  55. Stewart G. J., Tyler J. P., Cunningham A. L., Barr J. A., Driscoll G. L., Gold J., Lamont B. J. Transmission of human T-cell lymphotropic virus type III (HTLV-III) by artificial insemination by donor. Lancet. 1985 Sep 14;2(8455):581–585. doi: 10.1016/s0140-6736(85)90585-9. [DOI] [PubMed] [Google Scholar]
  56. Thiry L., Sprecher-Goldberger S., Jonckheer T., Levy J., Van de Perre P., Henrivaux P., Cogniaux-LeClerc J., Clumeck N. Isolation of AIDS virus from cell-free breast milk of three healthy virus carriers. Lancet. 1985 Oct 19;2(8460):891–892. doi: 10.1016/s0140-6736(85)90156-4. [DOI] [PubMed] [Google Scholar]
  57. Traisupa A., Wongba C., Taylor D. N. AIDS and prevalence of antibody to human immunodeficiency virus (HIV) in high risk groups in Thailand. Genitourin Med. 1987 Apr;63(2):106–108. doi: 10.1136/sti.63.2.106. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Van de Perre P., Rouvroy D., Lepage P., Bogaerts J., Kestelyn P., Kayihigi J., Hekker A. C., Butzler J. P., Clumeck N. Acquired immunodeficiency syndrome in Rwanda. Lancet. 1984 Jul 14;2(8394):62–65. doi: 10.1016/s0140-6736(84)90240-x. [DOI] [PubMed] [Google Scholar]
  59. Wendel S. N., Russo C., Bertoni R. R., Tsunoda N. M., Ghaname J. N. AIDS and blood donors in Brazil. Lancet. 1985 Aug 31;2(8453):506–506. doi: 10.1016/s0140-6736(85)90443-x. [DOI] [PubMed] [Google Scholar]
  60. Whyte B. M., Gold J., Dobson A. J., Cooper D. A. Epidemiology of acquired immunodeficiency syndrome in Australia . Med J Aust. 1987 Jan 19;146(2):65–69. doi: 10.5694/j.1326-5377.1987.tb136264.x. [DOI] [PubMed] [Google Scholar]
  61. Winkelstein W., Jr, Samuel M., Padian N. S., Wiley J. A., Lang W., Anderson R. E., Levy J. A. The San Francisco Men's Health Study: III. Reduction in human immunodeficiency virus transmission among homosexual/bisexual men, 1982-86. Am J Public Health. 1987 Jun;77(6):685–689. doi: 10.2105/ajph.77.6.685. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Wofsy C. B., Cohen J. B., Hauer L. B., Padian N. S., Michaelis B. A., Evans L. A., Levy J. A. Isolation of AIDS-associated retrovirus from genital secretions of women with antibodies to the virus. Lancet. 1986 Mar 8;1(8480):527–529. doi: 10.1016/s0140-6736(86)90885-8. [DOI] [PubMed] [Google Scholar]
  63. Zagury D., Bernard J., Leibowitch J., Safai B., Groopman J. E., Feldman M., Sarngadharan M. G., Gallo R. C. HTLV-III in cells cultured from semen of two patients with AIDS. Science. 1984 Oct 26;226(4673):449–451. doi: 10.1126/science.6208607. [DOI] [PubMed] [Google Scholar]
  64. Ziegler J. B., Cooper D. A., Johnson R. O., Gold J. Postnatal transmission of AIDS-associated retrovirus from mother to infant. Lancet. 1985 Apr 20;1(8434):896–898. doi: 10.1016/s0140-6736(85)91673-3. [DOI] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES