IntroductionLong-term natural history cohorts of HIV-1 in the absence of treatment provide the best measure of virulence by different viral subtypes.MethodsNewly HIV infected Ugandan and Zimbabwean women (N = 303) were recruited and monitored for clinical, social, behavioral, immunological and viral parameters for 3 to 9.5 years.ResultsUgandan and Zimbabwean women infected with HIV-1 subtype C had 2.5-fold slower rates of CD4 T-cell declines and higher frequencies of long-term non-progression than those infected with subtype A or D (GEE model, P < 0.001), a difference not associated with any other clinical parameters. Relative replicative fitness and entry efficiency of HIV-1 variants directly correlated with virulence in the patients, subtype D > A > C (P < 0.001, ANOVA).DiscussionHIV-1 subtype C was less virulent than either A or D in humans; the latter being the most virulent. Longer periods of asymptomatic HIV-1 subtype C could explain the continued expansion and dominance of subtype C in the global epidemic.

BV and yeast may contribute more to the HIV epidemic than previously thought.

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We determined the utility of an assay for 13 cancerassociated HPV types in primary cervical cancer screening of Zimbabwe women at high risk of HIV infection. HIV antibody status was determined by ELISA of oral mucosal specimens, and HPV DNA in the genital tract was identified by hybridization of cervical scrapes with probe B of Hybrid Capture II. Among the 466 women investigated, the prevalence of HPV, low-grade squamous intraepithelial lesions (LGSIL) and highgrade SIL (HGSIL) were 47.2%, 13.9% and 12%. Fifty-three and one-half percent of the women were HIV-seropositive. As compared with HIV-seronegative women, HIV-infected women had a greater than 2-fold HPV prevalence (64.3% vs. 27.6%), a greater than 7-fold amount of HPV DNA (RLU of 82.6 vs. 10.7) in HPV ؉ women assessed as normal on the reference standard, and a nearly 3-fold greater HGSIL prevalence (17.3% vs. Studies over the past 15 years have established conclusively that infections with certain HPV types are etiologically linked to invasive cervical carcinoma (Bosch et al., 1995). Implementation of Pap smear screening programs has reduced cervical cancer incidence in many of the industrialized countries, but such programs have been difficult to establish and maintain in the developing world. Several investigators have reported that human papillomavirus DNA tests may be an important additional tool for improving screening for cervical cancer and its precursor lesions (Meijer et al., 1992;Cuzick et al., 1995;Schneider et al., 1996;Herrero et al., 1997;Lorincz et al., 1999). However, most of these studies have been conducted in HIV Ϫ women. It is known that HIV-infected women have higher rates of HPV infections, squamous intraepithelial lesions (SIL) and cervical carcinoma (Kreiss et al., 1992;Wright et al., 1994;Vermund et al., 1991). Many populations that have a high prevalence of HIV infections also have a high incidence of cervical cancer (Mandelblatt et al., 1992).According to some investigators, there are significant limitations to cytology screening for the identification of SIL in HIV ϩ women as compared with the general population because of the more frequent occurrence of false negatives in HIV ϩ women. Based on this limitation, it has been suggested that colposcopy should be performed routinely for gynecological screening of HIV-infected women (Maiman et al., 1991;Fink et al., 1994;Del Priore and Lurain, 1995;Korn et al., 1994;Olaitin et al., 1997). Falsenegative Pap smears have been documented most often when the genital tract is infected with other organisms (Maiman et al., 1991). In a previous report (Womack et al., 1999), we presented the results of an evaluation of a test for high-risk HPVs (Hybrid Capture II, probe B) as an alternative to Pap smear in screening for cervical cancer in Zimbabwe, a country with a high incidence of cervical cancer and of HIV infection (Bassett et al., 1995;UNAIDS/WHO, 1997). In a subset (23%) of the subjects in that study, we obtained data on HIV prevalence by means of antibody assays of oral mucosal specimen...

In the first 6 months of life, IU and IP/ePP transmission contributed more than three-quarters of the 30.7% MTCT. Our data, in addition to serving as a historical comparison, may be useful in designing and evaluating the efficacy of short course antiretroviral trials aimed at reducing MTCT in developing countries.