Clinical and epidemiological features of HIV infection at a referral clinic in Zambia.

Among 1,350 patients with serologically confirmed HIV-1 infection evaluated at the Dermatovenerealogy Clinic, University Teaching Hospital. Lusaka, through March 1987, 125 (9.3%) had AIDS, 1,178 (87.3%) had AIDS-related complex, and 46 (3.5%) were asymptomatic. The male to female ratio of cases was 1.5:1 and women were younger (mean age of 26.2 years) than were men (mean age of 31.2 years). HIV-infected persons had significantly more lifetime sex partners than uninfected persons; other risk factors were a prior history of venereal disease, blood transfusion, travel abroad, and a positive syphilis serology. Clinical features in decreasing order of frequency were weight loss, persistent generalized lymphadenopathy, chronic cough, multidermatomal herpes zoster, diarrhea, recurrent fevers, tuberculosis, and oropharyngeal candidiasis. The WHO clinical case definition for the diagnosis of AIDS had a low positive predictive value for the 125 Zambians with AIDS, but among all those infected with HIV, the positive predictive value was 76.4%. Thirty (35.3%) of 85 patients who were HIV seronegative when first examined acquired HIV infections during a 12- to 39-month (means = 21.8 months) period of observation. Heterosexual intercourse unrelated to prostitution appears to be the major mode of HIV transmission in Lusaka.