[Clinical aspects of human immunodeficiency virus (HIV) infection in Central Africa: 6 years' experience at a hospital in an endemic area].

In Bangui (Central African Republic), where seroprevalence of HIV is 11% in the adult population, AIDS presents some clinical aspects different from the ones known in the west; the clinical experience reported in this paper is based on 504 cases infested by HIV group 4; diagnosis is very often made thanks to the clinical score recommended by World Health Organization (predictive value of 66%). Predominant manifestations (14%) are: asthenia (100%), emaciation (100%), fever (88%), diarrhea (42%), pulmonary attacks (37%), adenopathies, cutaneous manifestations (35%), neurological manifestations (14%). Some affections call for HIV infection with a significant predictive value: herpes zoster (96%), Kaposi's symptom (68%), mouth candidiasis (71%), pulmonary tuberculosis (56%: as far as some others are concerned, HIV has to be suspected: infant denutrition, acute infections, neurological disorders. Development is severe: 45% of the patients examined died in the 4 months coming after diagnosis. Epidemiology speaking, they are young patients (mean age 27.4 years), neither addicted nor "doped", heterosexual with multiple partners, with female prostitution occasionally; sex ratio is 0.95. Recognized transmission by transfusion is the exception (2/504). The transmission due to vaccination or injection is rare and difficult to evaluate. Only radical alteration of sexual behaviour will modify HIV dissemination.