A colour atlas of AIDS in the tropics

Abstract

The authors of this excellent Atlas include a medical artist, a dermatologist-venereologist, a surgeon and a paediatrician, all working in Lusaka, Zambia. It is in 3 parts. There is a brief introduction, "AIDS in the tropics". The core lies in the longer second part, "Early clinical manifestations and AIDS". The third part, "Prevention and health education", is a short text which cannot do justice in the space allotted to these enormously important subjects. The standard of clinical photography is of the highest quality: the lesions can be seen clearly in nearly every one of about 400 illustrations, despite the notorious difficulties of depicting changes in deeply pigmented skins. There are valuable series of photographs of post-mortem specimens, histopathology sections of Kaposi's sarcoma and radiographs of the chest. The most extensively illustrated sections are those on sexually transmitted diseases, cutaneous manifestations and Kaposi's sarcoma. Most usefully, pictures of lesions in HIV-negative patients are included for comparison. The contents of the Atlas do not reflect the relative frequencies of the lesions in the tropics. The commonest presentations in Africa are enteropathic AIDS or Slim, chronic lower respiratory tract infections and generalized lymphadenopathy. Any later editions of the Atlas could be strengthened by expansion of the relevant sections, for example by photographs of lymphadenopathy in different sites including the important epitrochlear region, histopathology of lymph nodes, and clinical, radiological and histopathological illustrations of pulmonary and extrapulmonary tuberculosis. The section on disease of the nervous system should be enlarged. The section on paediatric AIDS is of the utmost importance and will surely grow in subsequent editions. Room could be made for this proposed new material by reducing repetitions, both of the same patients and of the same conditions, for example chancroid, herpes zoster and candidiasis. Even some of the excellent photographs of Kaposi's sarcoma can be spared, when it is recalled that only about 4% of patients have this condition. There is a peculiar little section on AIDS-related complex (ARC) with inappropriate illustrations from patients who by definition have AIDS: the text could be incorporated into the section on the spectrum of HIV-related disease. The third part, however important the content, is out of place in a clinical atlas, and should be dropped. This Atlas is remarkably good value at #35 and is recommended to all clinicians concerned with the clinical diagnosis of AIDS in the tropics, or elsewhere. It would make a good gift to health workers with limited foreign exchange in developing countries. Alan F. Fleming