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The prevalence of antibody to hepatitis C virus (HCV) was estimated in 3 tropical populations using 2 screening ELISAs to detect antibody to the c100-3 antigen and 2 supplementary assays designed to test the specificity of these tests. Two hundred and eighty-six of 385 (74.2%) sera from Kiribati, 17 of 138 (12.3%) sera from Vanuatu, and 39 of 173 (22.5%) sera from Zaire were reactive in the initial screening assay. The proportion of reactive sera which were also reactive in the second screening ELISA varied between populations (55.1% in Kiribati, 85.1% in Vanuatu, and 39.2% from Zaire). Reactive sera were selected at random for confirmatory testing. Only 3 of 49 (6.12%) of sera from Kiribati and 1 of 14 (4.76%) of sera from Vanuatu positive in the initial ELISA were reactive in the confirmatory assays. The proportion of confirmed positive sera from Zaire was higher 8 of 28 (28.5%). Based on the results of these supplementary assays the estimated prevalence of anti-HCV in these populations is 4.8% in Kiribati, less than 1% in Vanuatu, and 6.4% in Zaire. Reliance on a single screening ELISA to estimate the prevalence of anti-HCV in stored sera from tropical communities may lead to a gross over-estimate of the true prevalence in these populations.

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Eight patients with AIDS and Pneumocystis carinii infection were studied. Protean manifestations were a feature not untypical of disseminated pneumocystosis. Aerosolised pentamidine as prophylaxis against P carinni pneumonia was ineffective at suppressing dissemination. The knowledge that extrapulmonary infection can occur has implications for the detection and treatment of, and prophylaxis against, P carinji infection. The survival of patients with disseminated pneumocystosis is particularly poor, and may be due to a lack of clinical awareness and consequent delay in diagnosis. A 26 year old homosexual man presented with severe abdominal pain. A chest x ray picture on admission showed bilateral pulmonary infiltrates suggestive of P carinii pneumonia. He had been found to be HIV antigen and antibody positive two years previously (November 1988). Mycobacterium malmoense had been isolated from sputum samples in June 1990 and at that time he had started quadruple anti-tuberculous treatment. He had developed an enlarged non-tender thyroid six weeks before admission and was found to be hypothyroid for which he was being treated with thyroxine. Auto-antibodies were not detected. He had received aerosolised pentamidine (300 mg fortnightly) as prophylaxis against P carinii pneumonia for six months. At laparotomy a perforation of the small bowel was found and repaired, but he died seven days later. CASE 32A 33 year old homosexual man presented with a history of weight loss, anorexia, dry cough, fever and night sweats. He had been found to be HIV-1 antibody positive three years previously and had developed P carinii pneumonia two years and again 10 months before admission. Since his first episode ofP carinii pneumonia he had been maintained on aerosolised pentamidine (300 mg fortnightly). He was feverish (39-4°C) and cachectic. His chest and abdomen were clinically normal, as were chest x ray picture and arterial blood gas analysis. Bronchoscopy