- Email: [email protected]
HTLV-I ANTIBODIES IN PAPUA NEW GUINEA
1137 with different dosages (Mantel-Haenszel), median survival rate 15 months. Zidovudine therapy is of some benefit for patients with AIDS and severe ARC. However, several treatment regimens have been usedl,2 and the optimum zidovudine dose still needs to be assessed. Our results indicate that zidovudine can inhibit HIV replication and ameliorate immunological and clinical values, even at the daily dose of 600 mg. We conclude that zidovudine should be administered at low dosages, which will reduce side-effects but retain the clinical benefits.
"L
Spallanzani" Hospital for
Infectious Diseases, 00149 Rome, Italy
P. SETTE V. TOZZI S. GALGANI G. TOSSINI
P. NARCISO M. P. CAMPORIONDO G. C. LEONI G. VISCO
1. Dournon E, Matheron S, Rozenbaum W, et al. Effects of zidovudine in 365 consecutive patients with AIDS or AIDS-related complex. Lancet 1988; ii: 1297-302. 2. Fischl MA, Richman DD, Grieco MH, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med 1987; 317: 185-91.
HIV-2 IN WEST AFRICA IN 1966
SIR,-Dr Kawamura and colleagues (Feb 18, p 385) claim that HIV-2 has been present in West Africa since 1966 or earlier. Of 197 sera collected from Nigeria in 1967, 2 (1-02%) were confirmed positive by western blot for antibodies to HIV-2. We have studied 4213 serum samples for HIV-2 over the past three years. The samples were from subjects who lived in different parts of Nigeria from Lagos in the south to Maiduguri in the north and who included patients with a variety of clinical syndromes, university students, female prostitutes, and pregnant women attending routine antenatal clinics. The sera were initially screened by ELISA ("ELAVIA 1’, ‘ELAVIA II’, and ‘ELAVIA MIXT’; Diagnostics Pasteur). Confirmation of positive samples was done by western blot (’LAVBLOT’, Diagnostics Pasteur). 23 sera (055%) were positive by ELISA, and 3 (0-07%) were confirmed by western blot. 1 of the samples was from a pregnant woman. She delivered a healthy baby five months later and has remained well to date. Serum from the baby was positive for HIV-2 by ELISA but negative by western blot. These findings cast doubt on the claim of Kawamura and colleagues that HIV-2 might have existed in West Africa as early as 1966. If our situation was parallel to that in central Africa, then there would have been a vast increase in HIV-2 infection in West Africa by now. This we have not seen, since the frequency by all accounts remains low in every part of the sub-region. Caution must be exercised when interpreting AIDS-related data in Africa to avoid unjustified stigmatisation. University of Maiduguri Teaching Hospital, PMB 1414,
Maiduguri, Nigeria
IDRIS MOHAMMED T. O. HARRY
previously recognised. Moresby General Hospital, Papua New Guinea
BART CURRIE
Shionogi Institute for Medical Science,
YORIO HINUMA JOKO IMAI
Port
Osaka, Japan Macfarlane Burnet Centre for Medical Research, Fairfield Hospital, Victoria 3078, Australia
SIMON CUMMING RICHARD DOHERTY
1. Babona DV, Nurse GT. HTLV-I antibodies in Papua New Guinea. Lancet 1988; ii: 1148. 2. Constantine NT, Fox E. Need to confirm HTLV-I screening assays. Lancet 1988; ii: 108-09. 3. Hrdy DB, Carlson JR, Yee JL, Armstrong MYK. Need to confirm HTLV-I screening assays. Lancet 1988; ii: 109. 4. Tsang VCW, Peralta JM, Simons AR. Enzyme linked immunoelectrotransfer blot techniques (EITB) for studying the specificities of antigens and antibodies separated by gel electrophoresis. Meth Enzymol 1983; 92: 377-91. 5. Brabin L, Brabin B, Doherty RR, et al. Patterns of migration and the epidemiology of human T-cell leukaemia virus type I infection in non-pregnant women in Papua New Guinea. Int J Cancer (in press). 6. Anonymous. Licensure of screening tests for anitibody to human T-lymphotropic virus type I. MMWR 1988; 37: 736-47.
DRUG ADVERTISING
Federal Vaccine Production Laboratory,
Yaba, Lagos, Nigeria
followed by confirmatory testing with western blot arid IF. 13-9% of these were judged positive.4.5 We have also tested available sera from patients with either haematological malignancies or with unexplained neurological disease. 2 patients with progressive spastic papaparesis of unknown aetiology were identified. 1 of them, a man aged about 45 from the Gulf Province of Papua New Guinea, had particle agglutination assay titres of 1/32, and reactivity to viral proteins of 19 and 24 kD (p 19, p 24) on western blot. IF was negative. A third patient, a 36-year-old man also from the Gulf Province was evaluated for a progressive neurological condition with predominantly extrapyramidal signs (tremor, rigidity, and bradykinesia). There was no conventional cause for his early onset parkinsonism. Screening by the Serodia assay was negative, but serum was positive for antibodies to HTLV-1 by western blot (bands at 19, 24, and 53 kD) and by IF (titre 1/40). Criteria for interpretation of western blots in HTLV-I infection have not been as well defined as those for HIV .6 It is possible that in Papua New Guinea there is a variant of HTLV-1 or even a novel retrovirus. We have described two examples of clinical disease with suggested association with HTLV-1 infection. The first of these demonstrates the problem of equivocal test results and the second the difficulty of an unequivocal laboratory result in the face of a clinical process not thought to be associated with HTLV-1 infection. Our second case might have an unrelated neurological process with latent and inactive HTLV-1 infection. In the absence of further similar cases, only sophisticated virological and neuropathological studies will show whether the parkinsonism is related to HTLV-I infection. We need, however, to remain alert to the possibility that new clinical associations with HTLV-1 infection may be found in areas where the presence of the virus has not been
A. NASIDI
HTLV-I ANTIBODIES IN PAPUA NEW GUINEA
SIR,-Babona and Nurse’ reported a 26-5% seropositivity for HTLV-1 in blood donors from Papua New Guinea in the ’Serodia’
(Fujirebio, Tokyo) particle agglutination assay. Constantine and Fox2 and Hrdy et aP showed that confirmatory testing of initial screening results is vital for the calculation of frequencies. The Serodia assay was used for initial screening of 280 coded samples from patients attending sexually transmitted diseases clinics in Papua New Guinea. All samples reactive in this assay were then tested by western blot and immunofluoresence (IF) 4s 32 samples (11 %) were positive by the Serodia assay, but only 8 (3%) were confirmed positive by western blot. 7 of these were also positive by IF. In a previous study in Papua New Guinea, 627 non-pregnant women were tested for HTLV-1 antibody by the Serodia assay,
SIR,-After reviewing misleading advertising in Pakistan, Dr Birley (Jan 28, p 20) concludes that drug companies will "carry on until effective local legislation arrives to control them". Dr Costa and Dr Figueras (March 18, p 618) call for "strict control measures by the health authorities" as the only way to overcome inappropriate drug marketing in Spain. However, governmental regulatory authorities do not have the power and resources to control drug companies unless they are assisted by the scientificmedical community. Arthur Yellin of the Food and Drug Administration (FDA) Division of Drug Advertising reports that "The vast majority of promotional materials submitted for consideration by the US FDA are false and/or misleading [but] the agency is able to take regulatory action in only about 5% of cases, primarily because of a lack of resources.1 It is unrealistic to expect less wealthy regulatory authorities to do better without outside support. Overreliance on government regulation may foster the complacent attitude among drug-company executives that responsibility for deciding whether their practices are acceptable
"L
Spallanzani" Hospital for
Infectious Diseases, 00149 Rome, Italy
P. SETTE V. TOZZI S. GALGANI G. TOSSINI
P. NARCISO M. P. CAMPORIONDO G. C. LEONI G. VISCO
1. Dournon E, Matheron S, Rozenbaum W, et al. Effects of zidovudine in 365 consecutive patients with AIDS or AIDS-related complex. Lancet 1988; ii: 1297-302. 2. Fischl MA, Richman DD, Grieco MH, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex: a double-blind, placebo-controlled trial. N Engl J Med 1987; 317: 185-91.
HIV-2 IN WEST AFRICA IN 1966
SIR,-Dr Kawamura and colleagues (Feb 18, p 385) claim that HIV-2 has been present in West Africa since 1966 or earlier. Of 197 sera collected from Nigeria in 1967, 2 (1-02%) were confirmed positive by western blot for antibodies to HIV-2. We have studied 4213 serum samples for HIV-2 over the past three years. The samples were from subjects who lived in different parts of Nigeria from Lagos in the south to Maiduguri in the north and who included patients with a variety of clinical syndromes, university students, female prostitutes, and pregnant women attending routine antenatal clinics. The sera were initially screened by ELISA ("ELAVIA 1’, ‘ELAVIA II’, and ‘ELAVIA MIXT’; Diagnostics Pasteur). Confirmation of positive samples was done by western blot (’LAVBLOT’, Diagnostics Pasteur). 23 sera (055%) were positive by ELISA, and 3 (0-07%) were confirmed by western blot. 1 of the samples was from a pregnant woman. She delivered a healthy baby five months later and has remained well to date. Serum from the baby was positive for HIV-2 by ELISA but negative by western blot. These findings cast doubt on the claim of Kawamura and colleagues that HIV-2 might have existed in West Africa as early as 1966. If our situation was parallel to that in central Africa, then there would have been a vast increase in HIV-2 infection in West Africa by now. This we have not seen, since the frequency by all accounts remains low in every part of the sub-region. Caution must be exercised when interpreting AIDS-related data in Africa to avoid unjustified stigmatisation. University of Maiduguri Teaching Hospital, PMB 1414,
Maiduguri, Nigeria
IDRIS MOHAMMED T. O. HARRY
previously recognised. Moresby General Hospital, Papua New Guinea
BART CURRIE
Shionogi Institute for Medical Science,
YORIO HINUMA JOKO IMAI
Port
Osaka, Japan Macfarlane Burnet Centre for Medical Research, Fairfield Hospital, Victoria 3078, Australia
SIMON CUMMING RICHARD DOHERTY
1. Babona DV, Nurse GT. HTLV-I antibodies in Papua New Guinea. Lancet 1988; ii: 1148. 2. Constantine NT, Fox E. Need to confirm HTLV-I screening assays. Lancet 1988; ii: 108-09. 3. Hrdy DB, Carlson JR, Yee JL, Armstrong MYK. Need to confirm HTLV-I screening assays. Lancet 1988; ii: 109. 4. Tsang VCW, Peralta JM, Simons AR. Enzyme linked immunoelectrotransfer blot techniques (EITB) for studying the specificities of antigens and antibodies separated by gel electrophoresis. Meth Enzymol 1983; 92: 377-91. 5. Brabin L, Brabin B, Doherty RR, et al. Patterns of migration and the epidemiology of human T-cell leukaemia virus type I infection in non-pregnant women in Papua New Guinea. Int J Cancer (in press). 6. Anonymous. Licensure of screening tests for anitibody to human T-lymphotropic virus type I. MMWR 1988; 37: 736-47.
DRUG ADVERTISING
Federal Vaccine Production Laboratory,
Yaba, Lagos, Nigeria
followed by confirmatory testing with western blot arid IF. 13-9% of these were judged positive.4.5 We have also tested available sera from patients with either haematological malignancies or with unexplained neurological disease. 2 patients with progressive spastic papaparesis of unknown aetiology were identified. 1 of them, a man aged about 45 from the Gulf Province of Papua New Guinea, had particle agglutination assay titres of 1/32, and reactivity to viral proteins of 19 and 24 kD (p 19, p 24) on western blot. IF was negative. A third patient, a 36-year-old man also from the Gulf Province was evaluated for a progressive neurological condition with predominantly extrapyramidal signs (tremor, rigidity, and bradykinesia). There was no conventional cause for his early onset parkinsonism. Screening by the Serodia assay was negative, but serum was positive for antibodies to HTLV-1 by western blot (bands at 19, 24, and 53 kD) and by IF (titre 1/40). Criteria for interpretation of western blots in HTLV-I infection have not been as well defined as those for HIV .6 It is possible that in Papua New Guinea there is a variant of HTLV-1 or even a novel retrovirus. We have described two examples of clinical disease with suggested association with HTLV-1 infection. The first of these demonstrates the problem of equivocal test results and the second the difficulty of an unequivocal laboratory result in the face of a clinical process not thought to be associated with HTLV-1 infection. Our second case might have an unrelated neurological process with latent and inactive HTLV-1 infection. In the absence of further similar cases, only sophisticated virological and neuropathological studies will show whether the parkinsonism is related to HTLV-I infection. We need, however, to remain alert to the possibility that new clinical associations with HTLV-1 infection may be found in areas where the presence of the virus has not been
A. NASIDI
HTLV-I ANTIBODIES IN PAPUA NEW GUINEA
SIR,-Babona and Nurse’ reported a 26-5% seropositivity for HTLV-1 in blood donors from Papua New Guinea in the ’Serodia’
(Fujirebio, Tokyo) particle agglutination assay. Constantine and Fox2 and Hrdy et aP showed that confirmatory testing of initial screening results is vital for the calculation of frequencies. The Serodia assay was used for initial screening of 280 coded samples from patients attending sexually transmitted diseases clinics in Papua New Guinea. All samples reactive in this assay were then tested by western blot and immunofluoresence (IF) 4s 32 samples (11 %) were positive by the Serodia assay, but only 8 (3%) were confirmed positive by western blot. 7 of these were also positive by IF. In a previous study in Papua New Guinea, 627 non-pregnant women were tested for HTLV-1 antibody by the Serodia assay,
SIR,-After reviewing misleading advertising in Pakistan, Dr Birley (Jan 28, p 20) concludes that drug companies will "carry on until effective local legislation arrives to control them". Dr Costa and Dr Figueras (March 18, p 618) call for "strict control measures by the health authorities" as the only way to overcome inappropriate drug marketing in Spain. However, governmental regulatory authorities do not have the power and resources to control drug companies unless they are assisted by the scientificmedical community. Arthur Yellin of the Food and Drug Administration (FDA) Division of Drug Advertising reports that "The vast majority of promotional materials submitted for consideration by the US FDA are false and/or misleading [but] the agency is able to take regulatory action in only about 5% of cases, primarily because of a lack of resources.1 It is unrealistic to expect less wealthy regulatory authorities to do better without outside support. Overreliance on government regulation may foster the complacent attitude among drug-company executives that responsibility for deciding whether their practices are acceptable