Confirmation that HIV causes Excess Death in Africa

84/28/94 11:32:35 VIA FAX -> JON COHEN Page 4
LANCET ID,: APR 20'94 9:46 No.003 P.04
EMBARGO DATE: APRIL 21, 7:00pm EST.
Conftrmaiou that HIV causes excess deaths hi Africa (pp 989U9Q, 1021-23)
A few maverick researchers and journalists take the minority view that HIV does not cause
death or even AIDS in Africa because there have beei tao data showing an enccss mortality
associated with HIV infection in teat cvuntry. That claim can no longer be substantiated if
a report by doctors ionn Uganda in The Lanet: this wck is anything to go by (pp 1021-23),
Dr Dut Mulder and colleagucs show unequivocally, in an epidemiological study of 9389
individuals from IS villagosin rural Uganda, the huge impact of HTV- r infection. LBetween
November 1989 and August 1990, blood samples were tAken from the inhabitants or the
village and tested for HIVMI antibody, followed by two years of observation
Mortality was 115.9 per 1000 among [l V-! positive individuals compared with only 7.1
per 1000 among HIV -1-seronegative individuals. The excess mortality due to HIV-1
infection was high in all age groups but especially so among men td women aged between
2 and 34. Adults in this age group were 60 tunes as likely to die within the two years
observation period as those who were IV negativt "A finding of this mngnitude, in an
age group which typically ain low mortality, is difficult to explain other than as a direct
causal effect of HIV-1 infection on mortality", say Mulder et at
They were careful to sck any factors that might have biased their results: but selactive
enrolment and non oomplianot are, they say, likely to have undenthmated mortality rates
sinooveilable data suggest that mortality wa kuhgher in tho' e who declined to take part.
in an accompanying commentary (pp 9X4-90), Dr Timothy Dondero and Dr James Curran
rnm the 1$ Centers fAt tiease Control and Prevention are in no doubt aWLi t the o
importance of this study, which, they say. "does a 1m1410 aViV ICe by quenxifying the grcatly
increased mortality due wo lIY infecuvua in one part of Africa At tbh ernae time in oquelohes
tite rnixchievvuv Qisim of some the; WIV en that continent anid the AIDS that results from
iL are unimportant".
(Cont eaw: Dr Dan* Mnifnd MRC' Researche Pwogrammc on AWNS In Uiganda, EntebNq, Vfanda; ggt IJ$6
42 21137 Vt Um sotrvy Podaro, DMr~son of IV/AI1D3, COC, Ar/an in, Georgia, 0/34; tl +1 494 419

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