A CLINICAL AND PATHOLOGICAL COMPARISON OF THE WHO AND CDC CASE DEFINITIONS FOR AIDS IN KINSHASA, ZAIRE - IS PASSIVE SURVEILLANCE VALID

Objectives: To compare the specificity of the World Health Organizatio n (WHO) and Centers for Disease Control and Prevention (CDC) case defi nitions for AIDS in autopsy cases from Zaire. Setting: Mama Yemo Hospi tal and University Hospital morgues in Kinshasa, and Karawa Hospital i n Equateur Region, Zaire. Methods: Autopsy cases with a clinical diagn osis of AIDS on the death certificate or chart were studied. Evaluatio n included post-mortem HIV-1 serology, chart review for specific AIDS- related symptoms and signs, and application of WHO and CDC case criter ia to the clinical and autopsy diagnoses. Results: Of the 68 diagnosed AIDS cases, 98% fulfilled WHO criteria for AIDS and 93% fulfilled bot h WHO and CDC criteria. All cases fulfilling both criteria were HIV-1- seropositive. Opportunistic infections accounted for 84% of CDC AIDS-d efining conditions. Disseminated tuberculosis was the most frequent (4 1%) specific diagnosis; Pneumocystis carinii pneumonia was rare (<2%). Conclusions: There was good concordance between WHO and CDC case defi nitions. A diagnosis of AIDS on the chart or death certificate is adeq uate for surveillance purposes in this population.