Acquired immune deficiency syndrome in Scandinavia.

Abstract

The number of patients with acquired immune deficiency syndrome (AIDS) in the four Scandinavian countries is shown in Table 1. In Denmark six of the patients had Kaposi's sarcoma, in Finland one patient had Kaposi's sarcoma and the other had Pneumocystis carinii pneumonia, whereas in Norway and Sweden none of the patients had Kaposi's sarcoma. Before June 1983, no cases of AIDS had been diagnosed in Finland. At that time, a study for screening Finnish homosexual men was started. In a gay disco in Helsinki, the prodromal symptoms and risk factors of AIDS were described, and persons with symptoms suggesting AIDS were invited to undergo an examination at the City Venereal Disease Clinic, Helsinki. Those persons with objective symptoms were examined more thoroughly at Aurora Hospital, Helsinki. A program was prepared for the reportees which ineluded a detailed questionnaire, a physical examination and several laboratory tests. The questionnaire covered the history of previous sexually transmitted diseases, including syphilis, gonococcal infections, non-gonococcal urethritis, herpes infections, penile or anal condylomata, hepatitis A and B, scabies, phthiriasis, and enteric infections with such organisms as Entamoeba histolytT'ca, Shigella, Salmonella and Giardia spp. Travel to the USA, Africa and Haiti during the past two years was recorded and also sexual practices during these trips. Questions were also asked on the use of recreational drugs, sexual practices and sexual life history. In the physical examination, special attention was paid to the skin and oral cavity to detect any lesions suggestive of Kaposi's sarcoma, All subjects were carefully examined for lymphadenopathy. The genital and anal areas were checked for infectious lesions. The laboratory tests consisted of ESR, complete blood cell count, platelet count, cardiolipin, skin reactivity to purified protein derivative of tuberculin (PPD, 2 TU), and OKT4/OKT8 T-cell ratio. Skin testing is useful in Finland because all newborn babies have been BCG-vaccinated since 1945. Two weeks after the screening was initiated, a 37 year old man with Kaposi sarcoma lesions on the skin and in the oral cavity was found and four weeks later a 26 year old man with cough, weight loss and intermittent fever, in whom Pneumocystis carinii pneumonia was diagnosed by bronchoalveolar lavage. Both patients showed a marked depression of cell-mediated immunity. The prompt finding of these two patients with manifest AIDS clearly demonstrates the value of the screening study.