Summary
Through epidemiological considerations we conclude that full-blown AIDS may occur only if the index patient is infected by the human immunodeficiency virus (HIV) and, in addition, by some other infectious coagent. Since the dynamical behaviour of the spread of AIDS cases with manifestation of Kaposi's sarcoma differs fundamentally from that of the non-Kaposi cases, we conjecture that two independent coagents (together with HIV) are responsible for the outbreak of full-blown AIDS with or without manifestation of Kaposi's sarcoma, respectively. Our formal epidemiological considerations appear to be supported by recent microbiological findings.
Keywords: Public Health, Internal Medicine, Human Immunodeficiency Virus, Infectious Disease, Sarcoma
Zusammenfassung
Aufgrund epidemiologischer Überlegungen wird geschlossen, daß Voll-AIDS möglicherweise nur dann auftritt, wenn der entsprechende Patient mit dem humanen Immundefizienzvirus (HIV) und außerdem mit einem weiteren infektiösen Koagens infiziert ist. Da sich die Ausbreitungsdynamik der AIDS-Fälle mit Manifestation von Kaposi-Sarkom wesentlich von der der Fälle ohne Kaposi-Sarkom unterscheidet, wird vermutet, daß für die Ausprägung von AIDS mit bzw. ohne Beteiligung von Kaposi-Sarkom jeweils eigenständige Koagenzien verantwortlich sind. Unsere formalen epidemiologischen Argumente scheinen durch neuere mikrobiologische Ergebnisse gestützt zu werden.
References
- 1.Lo S.-Ch., Shih J. W.-K., Yang N.-Y., Ou Ch.-Y., Wang R. Y.-H. A novel virus-like infectious agent in patients with AIDS. Am. J. Trop. Med. Hyg. 1989;40:213–226. doi: 10.4269/ajtmh.1989.40.213. [DOI] [PubMed] [Google Scholar]
- 2.Lo S.-Ch., Shih J. W.-K., Newton P. B., III, Wong D. M., Hayes M. M., Benish J. R., Wear D. J., Wang R. Y.-H. Virus-like infectious agent (VLIA) is a novel pathogenic mycoplasma: mycoplasma incognitus. Am. J. Trop. Med. Hyg. 1989;41:586–600. doi: 10.4269/ajtmh.1989.41.586. [DOI] [PubMed] [Google Scholar]
- 3.Lo S.-Ch., Dawson M. S., Wong D. M., Newton P. B., III, Sonoda M. A., Engler W. F., Wang R. Y.-H., Shih J. W.-K., Alter H. J., Wear D. J. Identification of mycoplasma incognitus infection in patients with AIDS: an immunohistochemical,in situ hybridization and ultrastructural study. Am. J. Trop. Med. Hyg. 1989;41:601–616. doi: 10.4269/ajtmh.1989.41.601. [DOI] [PubMed] [Google Scholar]
- 4.Montagnier L., Bernemann D., Guétard D., Blanchard A., Chamaret S., Rame V., van Rietschoten J., Mabrouk K., Bahraoui E. Inhibition de l'infectiosité de souches prototypes du VIH par des anticorps dirigés contre une séquence peptidique de mycoplasme. C. R. Acad. Sci. Paris. 1990;311(Série III):425–430. [PubMed] [Google Scholar]
- 5.Centers of Disease Control: AIDS public information data set, cases reported through June 1990 (electronic file). Atlanta 1990.
- 6.Fitzpatrick R., McLean J., Dawson J. Factors influencing condom use in a sample of homosexually active men. Genitourin. Med. 1990;66:346–350. doi: 10.1136/sti.66.5.346. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Hahn A. H., Onorato I. M., Jones T. St., Dougherty J. Prevalence of HIV infection among intravenous drug abusers in the United States. JAMA. 1989;261:2677–2684. [PubMed] [Google Scholar]
- 8.Bowie C., Ford N. Sexual behaviour of young people and the risk of HIV infection. J. Epidemiol. Community Health. 1989;43:61–65. doi: 10.1136/jech.43.1.61. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Johnson E. A., Petherick A., Davison S. J., Brettle R., Hooker M., Howard L., McLean K. A., Osborne E. M., Robertson R., Sonnex Ch., Tchamouroff St., Shergold C., Adler M. W. Transmission of HIV to heterosexual partners of infected men and women. AIDS. 1989;3:367–372. doi: 10.1097/00002030-198906000-00005. [DOI] [PubMed] [Google Scholar]
- 10.Biggar R. J., Brinton L. A., Rosenthal M. D. Trends in the number of sexual partners among American women. J. AIDS. 1989;2:497–502. [PubMed] [Google Scholar]
- 11.Padian N., Marquis L., Francis D. P., Anderson R. E., Rutherford G. W., O'Malley P. M., Winkelstein W. Male-to-female transmission of Human Immunodeficiency Virus. JAMA. 1987;258:788–790. [PubMed] [Google Scholar]
- 12.Padian N. S., Shiboski S. C., Jewell N. P. The effect of number of exposures on the risk of heterosexual HIV transmission. J. Infect. Dis. 1990;161:883–887. doi: 10.1093/infdis/161.5.883. [DOI] [PubMed] [Google Scholar]
- 13.Beral V., Peterman Th. A., Berkelman R. L., Jaffe H. W. Kaposi's sarcoma among persons with AIDS: a sexually transmitted infection? Lancet. 1990;335:123–128. doi: 10.1016/0140-6736(90)90001-l. [DOI] [PubMed] [Google Scholar]
- 14.Weyer J., Eggers H. J. On the structure of the epidemic spread of AIDS: The influence of an infectious coagent. Zentralbl. Bakteriol. 1990;273:52–67. doi: 10.1016/s0934-8840(11)80239-2. [DOI] [PubMed] [Google Scholar]
- 15.Weyer J. On the number of new infections generated by an HIV infected person. AIFO. 1990;5:31–40. [Google Scholar]
- 16.Hubbuch, F.: Ein mathematisches Modell zur epidemischen Dynamik von AIDS unter Berücksichtigung eines HIV-Kofaktors. Diplomarbeit, Universität zu Köln 1989.
- 17.Klenk H. D., Rott R. The molecular biology of influenza virus pathogenicity. Adv. Virus Res. 1988;34:247–281. doi: 10.1016/S0065-3527(08)60520-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Baseman J. B., Quackenbush R. L. Preliminary assessment of AIDS-associated mycoplasma. ASM News. 1990;56:319–323. [Google Scholar]
- 19.Chowdhury M. I. H., Koyanagi Y., Kobayashi S., Yamamoto N., Munakata T., Arai S. Mycoplasma and AIDS. Lancet. 1990;336:247–248. doi: 10.1016/0140-6736(90)91773-4. [DOI] [PubMed] [Google Scholar]
- 20.Editorial: Mycoplasma and AIDS — what connection? Lancet 337 (1991) 20-22. [PubMed]
- 21.Gallo R. C. Mechanism of disease induction by HIV. J. AIDS. 1990;3:380–389. [PubMed] [Google Scholar]
- 22.Lemaître M., Guétard D., Hénin Y., Montagnier L., Zerial A. Protective activity of tetracycline analogs against the cytopathic effect of the human immunodeficiency viruses in CEM cells. Res. Virol. 1990;141:5–16. doi: 10.1016/0923-2516(90)90052-k. [DOI] [PubMed] [Google Scholar]
- 23.O'Toole C., Lowdell M. Infection of human T cells with mycoplasma, inhibition of CD4 expression and HIV-1 gp120 glycoprotein binding, and infectivity. Lancet. 1990;336:1067. doi: 10.1016/0140-6736(90)92535-p. [DOI] [PubMed] [Google Scholar]
- 24.Couturier E., Ancelle-Park R. A., De Vincenzi I., Downs A. M., Brunet J. B. Kaposi sarcoma as a sexually transmitted disease. Lancet. 1990;335:1105. doi: 10.1016/0140-6736(90)92685-b. [DOI] [PubMed] [Google Scholar]
- 25.Dictor M., Bendsöe N. Transmissible agent of Kaposi sarcoma. Lancet. 1990;335:797. [PubMed] [Google Scholar]
- 26.Friedman-Kien A. E., Saltzman B. R, Cao Y., Nestor M. S., Mirabile M., Li J. J., Peterman Th. A. Kaposi's sarcoma in HIV negative homosexual men. Lancet. 1990;335:168–169. doi: 10.1016/0140-6736(90)90041-3. [DOI] [PubMed] [Google Scholar]
- 27.Garcia Muret M. P., Soriano V., Pujol R. M., Hewlett I., Clotet B., de Moragas J. M. AIDS and Kaposi sarcoma pre-1979. Lancet. 1990;335:969–970. [PubMed] [Google Scholar]
- 28.Kitchen V. S., French M. A. H., Dawkins R. L. Transmissible agent of Kaposi sarcoma. Lancet. 1990;335:797–798. [PubMed] [Google Scholar]
- 29.Root-Bernstein R. S. AIDS and Kaposi sarcoma pre-1979. Lancet. 1990;335:969. [PubMed] [Google Scholar]
- 30.Bary M., Vittecoq D., Liotier J. Y., Calamy G. Heterosexual transmission of the aetiological agent of Kaposi's sarcoma. Lancet. 1991;337:234. doi: 10.1016/0140-6736(91)92194-7. [DOI] [PubMed] [Google Scholar]