Causes and pathogenesis of AIDS in Africa:
As of November 1996,
the number of AIDS cases reported in Africa by the World Health
553,291 (Fauci et al., 1998).
Severe malnutrition has been
very well known to cause immune dysfunction and other serious health
effects and should be considered in the differential diagnosis in
HIV infected patients with AIDS and suffering from severe
malnutrition before implicating HIV as the cause of AIDS in Africa.
Actually the finding of atrophy of lymphoid tissue in people suffering
from malnutrition was observed as
early as 1925. For example, Jackson’s review on this topic in 1925
noted that many investigators had found a pronounced tendency of atrophy
of lymphoid tissue in all conditions of malnutrition. Thymus weight was
exquisitely sensitive to malnutrition and was earlier designated as the
“barometer of nutrition” (Woodruff, 1972).
is extensive literature describing the impact of malnutrition on the
function and the structure of the immune system in people in Africa (Al-Bayati,
1999). This information clearly demonstrates that AIDS in Africa is more
likely to be caused by starvation than by HIV. The functions of the
immune system, especially the cellular immunity, are impaired in
malnutrition cases. The severity of the impairment is dependent on the
degree of malnutrition in both human and animals. In studies of
345 malnourished children and two experimental models show the
impact of food deprivation
on the size of the thymus and the lymphoid organs.
For example, the size of the thymus of 42 malnourished children
was reduced by 90% as compared with a case-match normal controls (Parent
et al., 1994). In
a second study involving 110 malnourished children, the thymic area was
found to be 20% of the size in healthy children (Chevalier et al.,
result of studies that included 493 malnourished children who showed
impairment in the function of the immune system; especially the cellular
immunity (Al-Bayati, 1999).
results of autopsy of 118 malnourished children showed: 1) both thymus
and peripheral lymphoid tissues are reduced in bulk in states of
protein-calorie malnutrition (PCM), this reduction
being disproportionately greater than the loss of body weight.;
and 2) Severe thymic
atrophy was presented in 70% of marasmus cases and
85% of Kwashiorkor
cases. 59.3% of the children had marasmic and Kwashiorkor symptoms (Schonland,
1972). Fakhir et al., 1989 evaluated 100 severely malnourished children and
found that these children had a significant reduction in the absolute
lymphocytes count, T cells count,
and in the skin reaction to dinitrochloro benzene.
The lymphocyte function of 30
black children with PCM as assessed by the delayed hypersensitivity
reaction and morphology of lymphocyte transformation was found to be
impaired and serum cortisol level was elevated. The function of
lymphocyte and cortisol level returned to normal after 30 days of
feeding (Zeng et al., 1991).
levels of endogenous cortisol (a natural hormone) in plasma and urine
have been found to be abnormally elevated in malnourished patients.
Studies that included 159 malnourished children and 148 AIDS patients
who showed significant increases in cortisol levels (Membreno et al.,
1987; Piedrola, et al., 1996; Aref, et al., 1982; Schonland, et al.,
1972; Laditan, 1983; Zeng, et al., 1991).
in the lymphoid organs in malnourished people is caused by increased
levels of cortisol as well as by protein and vitamin deficiency. The
reduction in the thymus and the lymphoid tissue size and the reduction
in the function of the immune system of malnourished children and
animals were reversed after proper feeding. For example, the size of the
thymus increased from 20% of normal in a malnourished child to 107% of
normal following 9 weeks of proper feeding. The reversal of the
reduction in CD4+T cell count in HIV+ pregnant women following proper
feeding was also reported by Fawzi et al., (1998). Briefly, the
influence of diet on T cells counts in peripheral blood in 1,075
HIV-infected pregnant women who had poor nutritional status were
studied. The CD4+ T cell
counts of the women who received
multivitamin increased from 424/µL
to 596/µL during six
months of proper feeding.
incidence of starvation, parasitic diseases, septicemia, and low birth
weight are very high in Africa and other developing countries. As shown
in eleven studies that include the prevalence of malnutrition and
diseases in 1,425 infants and 5,834 children surveyed in nine countries
(Al-Bayati, 1999). For example, the mortality among 299 severely
malnourished children in Zambia was 25.8% (Gernaat et al., 1998).
Pneumonia and diarrhea were the major causes of death. In
India, 49% of 183 cases of lymphadenopathy in children were found to be
due to tuberculosis (Sheikh, et al., 1981).
1983 the World Health Organization estimated that 300 million children
had growth retardation secondary to malnutrition (Fauci et al., (1998).
High prevalence of
malnutrition and disease in Africa and other developing countries
is also reported by Fauci
et al., 1998 who stated that insufficient consumption of protein and
energy causes loss of both body mass and adipose tissue. Protein energy
malnutrition (PEM) occurs in developing nations and it may be present in
endemic form. Under famine conditions,
the prevalence of PEM may approach 25 percent. In children of
developing nations two syndromes of PEM have been distinguished:(1)
maramus, manifested by stunted growth, loss of adipose tissue,
generalized wasting of protein mass; and (2) kwashiorkor, manifested by
growth failure, edema, and hypoalbuminemia, fatty liver, and
preservation of subcutaneous. Mixed forms are common in both children
and adults (Fauci et al., 1998).
PEM cell-mediated immunity is impaired as indicated by all standard
tests (Fauci et al., 1998; Al-Bayati, 1999).
Further more, all wounds and incisions heal more slowly in PEM
and wound dehiscence is common. In woman with PEM, nearly every aspect
of reproduction is impaired, including implantation, fetal growth,
lactation, and parturition. The infants are stunted in size and may have
cognitive impairment if they survive (Fauci et al., 1998).
infections frequently precipitate clinical PEM because of the associated
diarrhea, associated anorexia, vomiting, increased metabolic needs, and
decreased intestinal absorption. Parasitic infections play a major role
in many parts of the world. Common infections and opportunistic
infections can lead to increased morbidity and mortality. Pneumonia is
common (Fauci et al., 1998).
prevalence of KS and
lymphoma, lymphadenitis, tuberculosis in Africa is similar to the male
homosexuals AIDS patients
in US and Europe and even higher (Al-Bayati, 1999). However, AIDS in
Africa occurs almost equally in males and females because starvation
affects both sexes equally. Sibanda
and Stanczuk, (1993)
reviewed all lymph node histopathology reports of lymph node
biopsy submitted to the Histopathology unit in Harare, Zimbabwe in the
period of January 1988 to June 1990. The commonest diseases in the 2,194
lymph node specimens were: non specific hyperplasia (33%), tuberculous
lymphadenitis (27%); metastases (12%), Kaposi’s sarcoma (9%); and
lymphomas (7%). Kaposi’s
sarcoma (KS) involving the lymph nodes was reported in 176 (9%) of the
lymph nodes. In children, the prevalence of KS was higher in children
under 5 years than in 6-15 year bracket. Approximately two thirds (65%)
of all patients with KS were aged between 20 and 40 years.
the large study of Fawzi et
al., 1998 clearly demonstrated HIV is
not implicated and
the impairment of the
immune system in a mother (HIV-positive)
who suffers from malnutrition can be reversed by feeding the mother
proper nutrition. This treatment also improved the outcome of pregnancy.
In Tanzania, 1,075 HIV-infected pregnant women between 12 and 27 weeks’
gestation received vitamin A (n=269), multivitamins excluding vitamin A
(n=269), multivitamins including vitamin A (n=270), or a placebo
(n=267). In this study, malnutrition
supplementation decreased the risk of low birth weight (<2500 g) by
44%, severe preterm birth (<34 weeks of gestation) by 39% and small
size for gestational age at birth by 43%. During pregnancy, all T-cells
subsets (CD4+, CD8+, and CD3+) increased in all groups between base-line
(mean 18 week’s gestation and 6 weeks postpartum). There was a
significantly larger increase in the CD4+ T cell counts and percentage
of CD4+ T cells among women assigned multivitamins. The mean increases
between base-line and 6 weeks postpartum were 167 cells/µL
and 112 cells/µL among women
on multivitamins and those on no vitamins, respectively. If
HIV were the cause of AIDS as the HIV-hypothesis claim, then
improved nutrition alone will never reverse the decline of
T cells in these HIV-positive women.
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