Clinical epidemiology, not seroepidemiology, is the answer to Africa's AIDS problem.

Abstract

The shortcomings of the "seroepidemiology" approach as opposed to the traditional "clinical epidemiology" approach in answer to Africa's acquired immunodeficiency syndrome (AIDS) problem, are discussed. Investigators with a knowledge of tropical medicine have observe that recurrent malaria and other infectious diseases are associated with excessively high rates of false-positivity with H9/HTV-III, enzyme linked immunoabsorbent assay (ELISA), leading to a dichotomy between seroepidemiology and clinical epidemiology in tropical Africa. In addition, patients with alcoholic liver disease have a high incidence of false positive results on tests for HTLV-III antibodies, while acute malaria infections have produced false positivity even with the Western blot. When the conclusions of clinical epidemiology differ from those of seroepidemiology, clinicians should always believe the former. Serological work should be limited to assessing the specificity and sensitivity of the various kits under African conditions, screening all blood before transfusion, and serving as a back up procedure when clinical features are not clear cut. In his Krobo tribe, in southeastern Ghana, Dr. Konotey-Ahulu suggests that the bulk of any available funds should be resourcefully utilized in answering the questions: how, when, who, which, why and where?