Acquired Immunodeficiency Syndrome: Meeting of the WHO Collaborating Centres on AIDS

Following a consultation on acquired immunodeficiency syndrome (AIDS) in April 1985, the World Health Organization (WHO) established a network of Collaborating Centres on AIDS to provide a framework for international cooperation, including training, provision of reference reagents, evaluation of methods, and epidemiologic surveillance (1). The directors of the WHO Collaborating Centres, together with other experts in virology and public health, met in Geneva, Switzerland, September 25-26, 1985, to make recommendations for WHO's 1986-1987 international activities on AIDS.

Participants at the meeting reviewed the epidemiologic status of AIDS and affirmed the disease was now a major public health problem in several countries of the developed and developing world. Over 13,000 AIDS cases were reported from 1981 to September 1985 in the United States, and the number of reported cases will probably double in 1986. More than 2,000 cases have been reported from 40 other countries. The Director-General of WHO expressed the great degree of concern felt in almost all 166 Member States of WHO regarding AIDS.

In the United States and western Europe, approximately 90% of cases among adults continued to occur in homosexual and bisexual men, intravenous drug users, and sexual partners of persons in these groups. Although it is expected that additional AIDS cases may develop in recipients of blood and blood products who are already infected with the causative virus of AIDS, lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III), future infections from blood and blood products can now virtually be considered preventable by screening blood donations for evidence of antibodies to the virus. Most pediatric cases of AIDS have occurred among children of persons in known risk groups. In several developing countries, however, most adult AIDS patients have been sexually active heterosexual men and women.

There is no evidence that LAV/HTLV-III is spread through casual contact with an infected individual, such as contact in family settings, schools, or other groups living or working together. The risk of infection of health-care workers seems very remote. At present, there is no evidence that blood-sucking insects transmit the disease.

The group concluded that an internationally accepted case definition of AIDS, relevant to its most severe clinical manifestations, was needed for surveillance purposes. For therapeutic trials or other research purposes, broader definitions may be required.

In countries where appropriate technologies are available, the surveillance definition for AIDS given by CDC and published by WHO (2) was endorsed by the group. Surveillance definitions are now being developed for use in countries where access to diagnostic techniques is limited.

The group concurred on the following issues:

1. For routine, large-scale testing for AIDS, the only practical methods currently available involve tests for antibodies to LAV/HTLV-III.

2. All sera reactive for anti-LAV/HTLV-III antibody in a radioimmunoassay (RIA) or enzyme-linked immunoabsorbent assay (ELISA) test should be confirmed by an independent test system, e.g., by immunoprecipitation or immunoblot tests. Assays for this antibody of higher specificity but lower sensitivity than that of conventional commercial ELISAs may be more appropriate for seroepidemiologic studies where confirmatory tests are not available.

3. Posttransfusion AIDS can be eliminated by excluding donors from groups at increased risk of infection and by screening all units of blood for antibodies to LAV/HTLV-III. Because infection can be transmitted from women to babies during the perinatal period, women who are antibody-positive should be advised to avoid pregnancy.

4. Reusing unsterile needles carries with it the risk of transmitting AIDS and other blood-borne infections. This procedure should be strongly discouraged.

5. The possible transmission of infectious diseases through the use of jet injection devices was discussed. After considering the available information, the group concluded that there was no evidence of a risk of transmission of blood-borne infection from using such devices.

6. Studies to identify effective therapeutic regimens for AIDS patients and work on developing vaccines are in progress in several countries. Successful therapy may require a combination of antiviral agents and substances that enhance immune responsiveness. Passive protection against infection is being pursued experimentally, including the use of monoclonal antibodies and hyperimmune gammaglobulin. Further work towards understanding the role of antibody in preventing and treating AIDS is required before these substances can be utilized in patients.

7. New antiviral drugs require careful study using the procedures of classical drug-evaluation protocols, under the guidelines of national control authorities. Studies to define the pharmacology, toxicity, and tolerated dosages must precede studies to determine the benefit.

8. Placebo-controlled studies in patients with mild forms of disease due to LAV/HTLV-III infection should be encouraged. Such studies will yield an answer on the efficacy of a drug more quickly and with fewer patients than the use of historic controls.

9. The prevalence of AIDS will depend heavily on the success of risk-reduction programs based on public information and education.

10. Because patients infected with LAV/HTLV-III often have immune-function abnormalities, administration of the commonly used live-virus vaccines (e.g., polio, measles) to such individuals could pose a theoretical risk. However, to date, no unexpected adverse reactions have been noted in individuals with antibody to LAV/HTLV-III, and such patients are free of overt signs of clinical AIDS when given the vaccines recommended by WHO for childhood or adult immunization programs.

11. T-lymphotropic retroviruses of simians provide potentially valuable models for studying the control and treatment of AIDS (3).

12. An important aspect of WHO activities on AIDS will be the collection of data on the incidence of the disease or its causative virus by Member States and the WHO Collaborating Centres and the regular transmission of this information to WHO headquarters. Wherever possible, information on the gender, age, recognized risk factor (if any), and major clinical features should also be provided A full report of the meeting is available from the Director,

Division of Communicable Diseases, WHO, Geneva. Adapted from WHO Weekly Epidemiological Record 1985;60:333-5.

References

1. WHO. Acquired immune deficiency syndrome (AIDS). WHO consultation. Weekly Epidemiological Record 1985;60:129-30.

2. WHO. Acquired immune deficiency syndrome (AIDS). Revision of the case definition of AIDS. Weekly Epidemiological Record 1985;60:270-1.

3. WHO. T-lymphotropic retroviruses of non-human primates. WHO informal meeting. Weekly Epidemiological Record 1985;60:269-70.

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