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What about disc degeneration? Figures for this condition are highly influenced by the method of definition; in the report by Hardcastle and colleagues, degeneration was probably determined by MRI, although this is not clearly stated. Such changes have been noted in 35% of young symptom-free subjects4,5 and might be expected to be higher in young athletes. In a control series of 13 batsmen described by Hardcastle et al, the frequency of disc degeneration was 54%. Thus fast bowling might contribute to disc degeneration in young men but is not the sole cause. Surveys with up-to-date sensitive techniques of investigation will always produce abnormal findings, which should be regarded cautiously, especially if they are not symptomatic. If they are, treatment must be considered. In most cases a stress fracture will heal with rest from the activity that initiated it. When it does not, selective surgery should be contemplated. Whether a stress fracture of the lumbar spine in a fast bowler constitutes an industrial or occupational disease has not been discussed. 1. Hardcastle

P, Annear DH, Foster DH, et al. Spinal abnormalities in young fast bowlers. J Bone Joint Surg 1992; 74B: 421-25. 2. Wynne-Davies R, Scott JHS. Inheritance and spondylolisthesis: a radiographic family survey. J Bone Joint Surg 1979; 61B: 301-05. 3. Weatherley CR, Mehdian H, Vanden Berghe L. Low back pain with fracture of the pedicle and contralateral spondylolysis. J Bone Joint Surg 1991; 73B: 990-93. 4. Evans W, Jobe W, Seibert C. Cross-sectional prevalence study of lumbar disc degeneration in a working population. Spine 1989; 14: 60-64. 5. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. J Bone Joint Surg 1990; 72A: 403-08.

AIDS minus HIV? Those attending the VIII International Conference AIDS in Amsterdam (July 19-24) were told of the dramatic discovery of a "new" virus not at a plenary session but in their hotel rooms on television. Peer-reviewed work presented in the scientific meetings was sidelined by an announcement to the press by Dr Sudhir Gupta in Irvine, California. Dr Gupta claims that the agent, human intracisternal virus (or MTV, media-transmitted virus, as delegates were quick to dub it) has caused an AIDS-like disease in a 66-year-old woman. The resultant stir forced an emergency session in Amsterdam, where Dr J. Laurence, Dr J. Curran, Dr A. Fauci, and others presented some of the privileged data from the Centers for Disease Control (CDC) and the National Institute of Alergy and Infectious Diseases concerning similar cases before publication of Laurence’s article in this issue of The Lancet on

tests were done for HIV-1 by enzymeimmunosorbent (ELISA) and assay immunoblotting, for HIV-2 by immunoblotting or by competition peptide ELISA, and for HTLV types I and II by immunoblotting. Cultures of peripheral blood mononuclear cells were assessed for p24 Gag antigen and by polymerase chain reaction amplification of DNA primers. Two of the patients were gay men, one was a woman who had received a blood transfusion, and two were heterosexual men. The patients were investigated for other causes of

serological linked

immunodeficiency, including malignant disease, but without success. Evidence of reverse transcriptase activity was found in two of them. At the meeting Dr Curran (head of the CDC HIV-AIDS programme) and Dr David Ho reported on other cases currently under investigation, and scientists at major HIV treatment centres in Europe and America described similar patients. In contrast to patients reported earlier, who presented with HIVnegative Kaposi’s sarcoma,l,2 the latest group had opportunistic infections typical of the clinical picture of HIV. Dr Curran ran into semantic difficulties as he attempted to distinguish these rare cases from the CDC surveillance case definition of AIDS; in fact the term "acquired immunedeficiency" describes them precisely, except for the absence of obvious HIV. This development raises a number of questions that must be addressed. Does a new virus causing a syndrome similar to HIV infection exist? Although numerous experts carefully stated that no such aetiological factor has been defined, it is possible that such an agent may yet be identified. These are case-reports rather than planned series, so there are several gaps in the information. For example, the CD4 lymphocyte depletion suggests an agent that is both lymphotropic and cytopathic. Was a cytopathic effect seen in the cultures? And what does the evidence of reverse transcriptase (RT) activity mean? RT activity can be seen with endogenous retroviruses or retroids, virus particles. As with HIV, it must be confirmed that patients, especially the cases described, have antibodies to the putative agent before a definite link can be established. Finally, why are all these cases, from disparate locations, suddenly appearing now? The media has created a panic with stories of a cover-up as well as public health concerns about blood supply and safety. The public does have a right to know-but know what? Further investigation is necessary to determine whether a new rare virus has indeed been identified or whether HIV is merely revealing to us another side of its tantalising face.

(p273). Laurence et al report five individuals from the New York City area who presented with clinical evidence of immunodeficiency and CD4 depletion but who had no evidence of human immunodeficiency virus (HIV) 1 or 2 infection. They have all been investigated by serological and molecular techniques; standard

1. Soriano V, Hewlett I, Friedman-Kien A, Tor J, Huang YI, Epstein J Definitive exclusion of HIV infection in a bisexual man with Kaposi’s sarcoma: suggestions of a pathogenic model of KS. VII International Conference on AIDS. Florence, Italy, June 16-21, 1991, Abstr TuB82. 2. Safai B, Peralata H, Menzies K, et al. Kaposi’s sarcoma among HIV seronegative high risk populations. VII International Conference on AIDS. Florence, Italy, June 16-21, 1991, Abstr TuB83.

AIDS minus HIV?

The identification of a small number of cases of clinical immunodeficiency and CD4 depletion but no evidence of human immunodeficiency virus (HIV) has...
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