The Relationship Between the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome: Executive Summary (Draft)

DRAFT

considerably higher--perhaps up to 110 million HIV infections and nearly 25 million AIDS cases by the turn of the century.
THE EVIDENCE THAT HIV CAUSES AIDS
1. Before the appearance of HIV, AIDS-like syndromes were rare.
Prior to the appearance of HIV, AIDS-related conditions such as Pneumocystis
carinii pneumonia (PCP), Kaposi's sarcoma (KS) and disseminated infection
with the Mycobacterium avium complex (MAC) were extraordinarily rare in the
United States. By June 30, 1993, 107,230 patients with AIDS in the United
States had been diagnosed with PCP, 30,055 with KS and 20,726 with disseminated MAC.
2. The main risk factors for AIDS - homosexual and heterosexual
promiscuity, transfusions and treatment for hemophilia, and injection drug
use - have existed for years, increasing only in a relative sense in recent
years.
If, as argued by some, these factors were themselves immunosuppressive, one
would expect to have seen a large number of AIDS-like syndromes among HIVseronegative blood recipients, hemophiliacs and users of recreational drugs
prior to the appearance of HIV. Reviews of the medical literature, autopsy
records and tumor registries indicate that such cases were extraordinarily rare.
3. AIDS and HIV infection are invariably linked in time, place and population
group.
Historically, the occurrence of AIDS-like illnesses in populations has closely
followed the appearance of HIV. The first cases of AIDS in homosexual men in
San Francisco were detected in 1981, and retrospective examination of frozen
blood samples from a cohort of gay men showed the presence of HIV
antibodies as early as 1978. Subsequently, in every country and city where
AIDS has appeared, evidence of HIV infection has preceded AIDS by just a few
years.
4. Numerous studies have shown that AIDS is common in populations with a
high seroprevalence of HIV antibodies. Conversely, in populations with
low seroprevalence of HIV antibodies, AIDS is extremely rare.
For example, Malawi, an African country with high seroprevalence of HIV
antibodies, reported 31,857 cases of AIDS to the WHO as of June 1994. In
contrast, Madagascar, an island country off the southeast coast of Africa with a
very low seroprevalence of HIV antibodies, reported only 9 cases of AIDS to
the WHO through June 1994.

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