ß-Caryophyllene: A Therapeutic Alternative for Intestinal Barrier Dysfunction Caused by Obesity.

Obesity is an excessive accumulation of fat that exacerbates the metabolic and inflammatory processes. Studies associate these processes with conditions and dysregulation in the intestinal tract, increased concentrations of lipopolysaccharides (LPSs) in the blood, differences in the abundance of intestinal microbiota, and the production of secondary metabolites such as short-chain fatty acids. ß-Caryophyllene (BCP) is a natural sesquiterpene with anti-inflammatory properties and with the potential purpose of fighting metabolic diseases. A diet-induced obesity model was performed in 16-week-old C57BL/6 mice administered with BCP [50 mg/kg]. A reduction in the expression of Claudin-1 was observed in the group with a high-fat diet (HFD), which was caused by the administration of BCP; besides BCP, the phylaAkkermansia and Bacteroidetes decreased between the groups with a standard diet (STD) vs. HFD. Nevertheless, the use of BCP in the STD increased the expression of these phyla with respect to fatty acids; a similar effect was observed, in the HFD group that had a decreasing concentration that was restored with the use of BCP. The levels of endotoxemia and serum leptin increased in the HFD group, while in the HFD + BCP group, similar values were found to those of the STD group, attributing the ability to reduce these in conditions of obesity.

Effectiveness of antibiotic treatment in infertile patients with sterile leukocytospermia induced by tobacco use.

Our study investigated whether antibiotic therapy in infertile tobacco users with sterile leukocytospermia and a history of former sexual transmitted disease (STD) has an advantage over cessation of smoking alone. For this study, 80 male infertile smokers were divided into two subgroups. The first group numbered 40 patients treated with a two week course of doxycycline, 100 mg, twice daily, while the second group simply ceased smoking. A control group of 20 patients with chronic abacterial prostatitis (CPPS III a) were treated with the same antibiotic for two weeks. Patients from the first group exhibited significantly higher values in semen volume, total motility, and progressive motility of spermatozoa, when compared with the second group, two weeks post treatment. The latter two measures persisted during the 12 week follow up period. In both groups of patients, the correlation coefficient between the number of leukocytes and progressive motility was determined as statistically significant. However, in the control group the correlation was not statistically significant; however progressive motility, total motility, and vitality were significantly improved after a two week course of antibiotics. Our study implies that antibiotic treatment is perhaps effective in treating sterile leukocytospermia in smokers with a former STD and is a more effective treatment option in improving sperm parameters over smoking cessation alone. ABBREVIATIONS: STD: sexual transmitted disease; CPPS IIIa: chronic abacterial prostatitis; PSA: prostatic specific antigen; EPS: expressed prostatic secretion; WBC: white blood count; LUTS: lower urinary tract symptoms; PPMT: pre-massage and post-massage urine test; VAS: visual analogue scale.

Sexually Transmitted Pathogens, Depression, and Other Manifestations Associated with Premenstrual Syndrome.

This study investigated whether sexually transmitted infections and lifestyle variables are associated with premenstrual syndrome (PMS) as well as particular manifestations commonly associated with PMS. Data were gathered from medical records of 500 regularly cycling women. The following infectious agents were investigated: human papillomavirus, Chlamydia trachomatis, Neisseria gonorrheae, Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis. Bivariate tests and multivariate logistic regressions were used to evaluate whether these pathogens were associated with headache, pain, nausea, and depression. Chlamydia trachomatis was significantly associated with premenstrual syndrome (PMS) and two common manifestations of PMS: depression and pain. Trichomonas vaginalis was significantly correlated with headache and Gardnerella vaginalis with nausea. None of the illness manifestations was significantly associated with the tested lifestyle variables: dietary calcium supplementation, alcohol and drug use, exercise, and smoking. These associations provide a basis for assessment of infectious causation of PMS and several manifestations of illness that are commonly associated with PMS.

Knowledge and acceptability of Chlamydia trachomatis screening among pregnant women and their partners; a cross-sectional study.

BACKGROUND: Chlamydia trachomatis infections in pregnancy can cause maternal disease, adverse pregnancy outcomes and neonatal disease, which is why chlamydia screening during pregnancy has been advocated. The effectiveness of a screening program depends on the knowledge of health care professionals, women and partners and the acceptability for screening of the target population. We assessed the knowledge of chlamydia infection among pregnant women and their partners in the Netherlands, their attitudes towards testing, and their experiences of being offered a chlamydia test. In addition, we evaluated the association between participants' background characteristics and knowledge of chlamydia. METHODS: Pregnant women aged ≤ 30 years and their partners (regardless of their age) attending one of the participating primary midwifery care practices in the Netherlands were invited to participate. All participants completed a questionnaire, pregnant women provided a vaginal swab and partners provided a urine sample to test for C. trachomatis. RESULTS: In total, 383 pregnant women and 282 partners participated in the study of whom 1.9% women and 2.6% partners tested chlamydia positive. Participants had high levels of awareness (92.8%) of chlamydial infection. They were knowledgeable about the risk of chlamydia infection; median knowledge score was 9.0 out of 12.0. Lower knowledge scores were found among partners (p-value <0.001), younger aged (p-value 0.02), non-western origin (p-value <0.001), low educational level (p-value <0.001), and no history of sexually transmitted infections (p-value <0.001). In total, 78% of respondents indicated that when pregnant women are tested for chlamydia, their partners should also be tested; 54% believed that all women should routinely be tested. Pregnant women more often indicated than partners that testing partners for chlamydial infection was not necessary (p-value <0.001). The majority of pregnant women (56.2%) and partners (59.2%) felt satisfied by being offered the test during antenatal care. CONCLUSION: Pregnant women and their partners were knowledgeable about chlamydial infection, found testing, both pregnant women and their partners, for chlamydia acceptable and not stigmatizing.

Integration of HIV and maternal healthcare in a high HIV-prevalence setting: analysis of client flow data over time in Swaziland.

OBJECTIVE: Maternal and child health (MCH) care may provide an entry point for HIV services in high HIV-prevalence settings. Our objective was to assess integration of HIV with MCH services in public sector facilities in Swaziland. DESIGN: In 2009, 2010 and 2012, client flow assessments (CFAs) were conducted over 5 days in the MCH units of eight government facilities, purposively selected as intervention or comparison sites. PARTICIPANTS: 8263 MCH visits with female clients were tracked: 3261 in 2009, 2086 in 2010 and 2916 in 2012. INTERVENTION: Activities and resources to strengthen integration of HIV services into postnatal care (PNC), 2009-2010. MAIN OUTCOME MEASURES: The proportion of all visits in which an HIV/sexually transmitted infection (STI) testing, counselling or treatment was received together with an MCH service; the proportion of all visits in which a client receives HIV counselling. RESULTS: Across facilities, the proportion of visits in which HIV/STI and MCH services were received varied considerably, for example, from 9% to 49% in 2009. HIV/STI services were integrated most frequently with child health (CH), antenatal care (ANC) and family planning (FP)-the most common reasons for women's attendance-and least often with PNC and cervical screening (CS). There was no meaningful difference in integration over time by design group and considerable heterogeneity across facilities. Receipt of integrated services increased in one intervention and two comparison facilities, where HIV counselling also rose, and fell in one intervention and two comparison facilities. CONCLUSIONS: Provision of HIV/STI services with MCH care occurred at all facilities, yet relatively few women receive integrated services. Increases in integration were driven by increases in HIV counselling, while sharp declines in some facilities indicate that integration is difficult to sustain. Opportunities for intensifying HIV integration lie with ANC, CH and FP, while HIV-PNC integration will remain limited until more women attend PNC. TRIAL REGISTRATION NUMBER: Current Controlled Trials NCT01694862.

High prevalence of sexually transmitted infections in HIV-infected men during routine outpatient visits in the Netherlands.

BACKGROUND: In the Netherlands, no guidelines exist for routine sexually transmitted infection (STI) screening of human immunodeficiency virus (HIV)-infected men having sex with men (MSM). We assessed prevalence and factors associated with asymptomatic STI. METHODS: MSM visiting HIV outpatient clinics of academic hospitals were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, and hepatitis B and C infection. Prevalence and risk factors were studied using logistic regression. RESULTS: In total, 659 MSM were included between 2007 and 2008. STI were found in 16.0% of patients, mostly anal CT and syphilis. One new hepatitis B and 3 new hepatitis C infections were identified. In multivariate analyses, any STI (syphilis, CT, or NG) was associated with patient's age below 40 years (odds ratio [OR]: 2.5, 95% confidence interval [CI]: 1.3-5.0), having had sex with 2 or more sexual partners (OR 2.1, 95% CI: 1.2-3.5), the use of the same sexual toys with a sexual partner (OR 2.2, 95% CI: 1.0-4.9), and enema use before sex (OR: 2.3, 95% 1.2-4.2). Syphilis was independently associated with fisting with gloves versus no fisting (OR: 4.9, 95% CI: 1.7-13.7) and with rimming (OR: 5.0, 95% CI: 1.7-15.0). CT or NG were associated with age below 45 years (age 40-44 years: OR: 2.4, 95% CI: 1.1-5.3; age <40 years: OR: 2.4, 95% CI: 1.1-5.4), enema use before sex (OR: 2.4, 95% CI: 1.3-4.4) and drug use during sex (OR: 2.4, 95% CI: 1.4-4.0). CONCLUSIONS: High-risk sexual behavior was very common, and 16% of HIV-infected MSM in HIV care had an asymptomatic STI, mostly anal CT and syphilis. Development of STI screening guidelines is recommended.

Caracterización clínica y epidemiológica de adolescentes con VIH y /o sida del centro de Atención Integral del Hospital Nacional Dr. Mario Catarino Rivas en el período comprendido de enero 2010 a junio 2011 / Clinical and Epidemiological Characterization of Adolescents with HIV and / or AIDS from the Comprehensive Care Center of the Dr. Mario Catarino Rivas National Hospital in the period from January 2010 to June 2011

OBJETIVOS. Documentar una caracteri - zaci ón cl ínica y epidemiol ógica de adoles - centes con VIH y/o Sida atendidos en el Hospital Dr. Mario Rivas de Enero 2010 a Junio del 2011 y abrir la brecha de investiga - cio nes futuras en otros centros. MATERIALES Y M ÉTODOS. Estudio descriptivo transversal, prospectivo, con recolecci ón de datos mediante interrogatorio directo al paciente y sus cuidadores, complementando con el expediente cl ínico, aplic ándose un instrumento de trabajo de tipo formulaci ón a 214 adolescentes con VIH Sida RESULTADOS. El 85 % de los adolescentes est án entre 11 y 18 a ños, el 18% de los mayores de 18 añ os han pasado a consulta de adultos. En su mayor ía son hu érfanos de padre, madre o ambos (66%), 22% viven en hogares y un 2% viven en parejas. Se establece que un 6% no estudia. La categor ía clínica C3 fue la m ás frecuente al momento del diagn óstico, sin embargo el 66% tení a inmunosupresi ón severa al momento del diagnostico. Se registra un 13% con fracaso virol ógico mayor de 2,000 copias. Un 19% de los adolescentes utiliza terapia de rescate. El 32% ha presentado alg ún efecto adverso con la terapia antirretroviral. El 3% de las mujeres se ha embarazado. El 95% de los adolescentes conoce su estado serol ógico y el 35% han ameritado apoyo psicol ógico en alg ún momento. En esta cohorte el 0.5% han fallecido. CONCLUSIONES. Se recomienda la formaci ón de grupos de auto apoyo juveniles que fomenten la adherencia y su participaci ón social as í como tambi én inc luir de forma real el apoyo nutricional en el con- cepto de atenci ón integral, fortalecer y coor - dinar con la cl ínica de adultos el paso de los adolescentes y continuar la educaci ón sexual en los adolescentes con VIH. Se discuten otros aspectos cl ínicos y e pidemiol ógicos.

[Clinical research on Linbiqing decoction for the treatment of chronic prostatitis following sexually transmitted disease].

OBJECTIVE: To study the therapeutic effect of Linbiqing decoction on chronic prostatitis following sexually transmitted disease (CPFSTD). METHODS: Linbiqing decotion was given orally to 36 patients with CPFSTD, and the therapeutic effet was assessed by observing the clinical symptoms and measuring the objective indexes before and after the treatment. RESULTS: Four to eight weeks after the drug administration, the overall effectivity rate was 72.22%, and the scores of NIH-CPSI were decreased significantly. CONCLUSION: Linbiqing decoction has definite therapeutic effect on CPFSTD, and can be considered as an effective means for the treatment of the disease.

[Related pathogen examinations and therapeutic choices for chronic prostatitis following sexually transmitted diseases].

OBJECTIVE: To explore the etiologic relationship between sexually transmitted diseases(STDs) and chronic prostatitis (CP), and to evaluate the effect of multiple treatment on CP following STDs. METHODS: Seventy-two cases of CP after STDs were randomly divided into three groups: Group A (treated with levefloxatin), Group B (treated with Levofloxacin, terazosin and microwave), and Group C (treated with levofloxacin, Chinese traditional medicine and microwave), all treated for thirty days. The pathogens related to STDs in the prostatic fluid of all the patients had been examined before treatment. The efficacy was evaluated among the three groups by comparing the count of leukocytes and the scores of NIH-CPSI before and after treatment. RESULTS: The pathogens related to STDs were found in the prostatic fluid of 7 patients. The count of leukocytes and the scores of NIH-CPSI decreased after treatment in the three groups, more markedly in Groups B and C than in Group A. CONCLUSION: There is no strict etiological causality between STDs and CP. Multiple treatments are superior to single antibiotic treatment.

HIV health care services for Mexican migrants.

This article reviews the literature on HIV/AIDS health care services for Mexican migrants in the United States. Because so little research has been conducted on Mexican migrants per se, we include literature on Latinos/Hispanics in the United States, because some characteristics may be shared. Furthermore, we focus special attention on data from California because it is on the front line of issues regarding health care for Mexican migrants. The types of health care services needed to improve on the quality of care provided to Mexican migrants living with HIV are highlighted, and recommendations are made for future interventions, research, and binational collaborations.

Incident sexually transmitted infections and their risk factors in an Aboriginal community in Australia: a population based cohort study.

OBJECTIVE: To identify risk factors for incident sexually transmitted infections (STI) in a remote Aboriginal community in Australia. DESIGN: A population based cohort study. SETTING: An Aboriginal community in central Australia. PARTICIPANTS: 1034 Aboriginal people aged 12-40 years, resident in the study region, seen during the period 1 January 1996 to 30 June 1998 for STI diagnosis. MAIN OUTCOME MEASURES: Incident rate of gonorrhoea, chlamydia, and syphilis per 100 person years. RESULTS: There were 313 episodes of incident gonorrhoea, 240 of incident chlamydial infection, and 17 of incident syphilis. For gonorrhoea, risk factors were age, substance abuse, and previous prevalent chlamydial infection with a rate ratio (RR) of 3.2 in people aged 15-19 years, 1.6 in people who abused alcohol, and 3.2 in women who had sniffed petrol on a regular basis. For chlamydia, risk factors were sex, age, and a previous history of STI with a RR of 2.7 in people aged 15-19 years. Similar factors were associated with an increased risk of syphilis but the associations were not statistically significant. CONCLUSION: This study identified objective predictors of incident STI which can be used to target interventions and maximise their impact. The results of this study may well have relevance to indigenous communities in other countries that are faced with high levels of STI and substance abuse.

El VIH y el sida en las Americas: una epidemia con muchas caras / HIV and AIDS in the Americas: an epidemic with many faces

This document presents data that was analyzed at a joint meeting of the Monitoring the AIDS Pandemic Network and the LAtin America and Caribbean Epidemiological Network for HIV/AIDS, held in Rio de Janiero from 4 to 5 November 2000, along with the final recommendations of that meeting. The report focuses on the diversity of the global HIV/AIDS pandemic, a diversity that is particularly evident in Latin America and the Caribbean. After providing an overall perspective on the epidemic in the Americas, the report describes the epidemic in different areas of the Americas: the Andean Subregion, Brazil, the Caribbean, Central America, Mexico, the Southern Cone, and North America. The problem of infections associated with HIV/AIDS is also addressed, especially tuberculosis, as well as other sexually transmitted infections. Also analyzed are achievements and challenges in preventing HIV infection, both in groups that are considered low risk (heterosexual adults) and those of high risk (men who have sex with men, intravenous drug users, young people, and marginalized populations). Other aspects analyzed are efforts to improve HIV surveillance, new antiretroviral agents and their impact, and the prevention of vertical transmission of HIV (AU)

A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda.

OBJECTIVE: To describe the design and first-round survey results of a trial of intensive sexually transmitted disease (STD) control to reduce HIV-1 incidence. STUDY DESIGN: Randomized, controlled, community-based trial in Rakai District, Uganda. METHODS: In this ongoing study, 56 communities were grouped into 10 clusters designed to encompass social/sexual networks; clusters within blocks were randomly assigned to the intervention or control arm. Every 10 months, all consenting resident adults aged 15-59 years are visited in the home for interview and sample collection (serological sample, urine, and, in the case of women, self-administered vaginal swabs). Sera are tested for HIV-1, syphilis, gonorrhea, chlamydia, trichomonas and bacterial vaginosis. Following interview, all consenting adults are offered directly observed, single oral dose treatment (STD treatment in the intervention arm, anthelminthic and iron-folate in the control arm). Treatment is administered irrespective of symptoms or laboratory testing (mass treatment strategy). Both arms receive identical health education, condom and serological counseling services. RESULTS: In the first home visit round, the study enrolled 5834 intervention and 5784 control arm subjects. Compliance with interview, sample collection and treatment was high in both arms (over 90%). Study arm populations were comparable with respect to sociodemographic and behavioral characteristics, and baseline HIV and STD rates. The latter were high: 16.9% of all subjects were HIV-positive, 10.0% had syphilis, and 23.8% of women had trichomonas and 50.9% had bacterial vaginosis. CONCLUSIONS: Testing the effects of STD control on AIDS prevention is feasible in this Ugandan setting.

PIP: An ongoing (1994-98) randomized, community-based trial in Uganda's Rakai District is assessing the assumption that intensive sexually transmitted disease (STD) control efforts result in marked declines in HIV/AIDS prevalence. Described, in this article, are the project design and findings of the first-round baseline survey. 56 communities were grouped into 10 clusters designed to encompass social/sexual networks and clusters within blocks were randomly assigned to the intervention or control arm. All consenting permanent residents of the district are visited in their homes at 10-month intervals where they are administered extensive questionnaires, provide urine and vaginal swab samples, and are offered mass treatment regardless of symptoms or laboratory testing (single oral dose STD treatment in the intervention arm and anthelmintics and iron folate in the control arm). Both groups receive identical health education, condom promotion, and serologic counseling services. In the first round of home visits, 5834 intervention and 5784 control arm subjects were enrolled, representing about 90% of eligible adults. The groups were comparable in terms of sociodemographic and behavioral characteristics and baseline rates of HIV and STDs. 16.9% of subjects were HIV-positive, 10.0% had syphilis, 23.8% of women had trichomonas, and 50.9% had bacterial vaginosis. Detailed STD assessment is expected not only to document the relationship between STD control and HIV, but also to identify which STDs confer the greatest population attributable risk for HIV transmission, facilitating targeted control efforts in the future.

HIV/STD integration: new data help forge linkage.

AIDS: HIV and STDs are being linked through clinical and epidemiological studies, and coordination of services is being pushed more aggressively. The Centers for Disease Control and Prevention (CDC) will publish guidelines later this year on how to integrate HIV and STD screening and services. Effective STD prevention is an essential part of effective HIV prevention, and the guidelines are an outgrowth of research on co-infection rates. A table includes case rates for selected STDs in the United States.^ieng

Common gynecologic infections.

AIDS: Gynecologic manifestations are frequently reported by women with HIV. Although many symptoms also occur in HIV-negative women, the conditions are often more serious, occur more frequently, and are harder to treat in HIV-positive women. A chart groups the infections into four types: viral, bacterial, protozoal, and fungal. The chart includes possible symptoms, how the infection is diagnosed, treatment options, alternative therapies, and other information on the condition. The listed conditions include bacterial vaginosis, herpes simplex virus, human papillomavirus, pelvic inflammatory disease, and molluscum. The most common sexually transmitted diseases, chlamydia, gonorrhea, and syphilis, are not included.^ieng

Hepatitis C virus infection in a male homosexual cohort: risk factor analysis.

BACKGROUND: Hepatitis C virus (HCV) infection is a major cause of morbidity throughout the world. Parenteral exposure to infected blood accounts for the majority of cases. Sexual transmission is suggested by the higher prevalence of infection in sex workers and homosexual men. Sexual practices which contribute to HCV infection need to be identified. METHODS: The social and medical history, and HCV serostatus of 1058 homosexual men in the Pittsburgh arm of the Multicenter AIDS Cohort Study were analysed. Multivariate analysis was used to determine risk factors for HCV seropositivity. RESULTS: 31 men were HCV seropositive by enzyme immunoassay and recombinant immunoblot assay (2.9%). They were more likely to be HIV seropositive (39%) than the HCV seronegative men (19%). Needle sharing and illegal drug use were the most important risk factors for HCV seropositivity. Statistically significant sexual factors (p < 0.05) included a history of syphilis, rectal gonorrhea, anal insertive intercourse with ejaculation, and douche or enema use before anal receptive intercourse. The number of sexual partners was not a significant risk factor. CONCLUSIONS: HCV infection is associated with specific sexually transmitted diseases (STDs) and sexual practices in the male homosexual population. The evidence of high risk behavior should be incorporated into ongoing educational efforts to decrease the incidence of STDs.

Sexually transmitted diseases: current and emerging concerns.

Sexually transmitted diseases (STDs) are epidemic today, with the highest prevalence being among adolescents and young adults. If any decrease in incidence is to occur, nurses must make a determined effort to identify at-risk individuals and groups and empower them through teaching and counseling about strategies of primary and secondary prevention. Current and emerging concerns that make prevention of STDs difficult include such problems as the huge reservoir of infected individuals with no symptoms, the synergy between STDs and human immunodeficiency virus infections, and the particular vulnerability of women to STDs based on their biology. A holistic approach to care that is sensitive to the age, race, culture, and core group characteristics is essential for effective prevention efforts.

The situation in Africa.

More than three million women world-wide are infected with HIV, and women will constitute 40% of the new AIDS cases in 1990-1991. Unlike in the industrialized world, HIV in Africa is heterosexually transmitted and thus affects at least as many women as men. Already the leading cause of death in a major African city, HIV may be spreading to rural areas. In spite of improvement in surveillance, under-reporting makes it difficult to project trends, document differences within and between urban and rural areas, and identify at-risk groups. Increasing evidence shows that STDs play a major role in spreading the HIV epidemic. Male-to-female transmission is more efficient owing to factors related to the pathogen and the host. Ulcerative STDs such as chancroid, syphilis and herpes facilitate HIV entry through mucosal discontinuation and recruitment of HIV target cells. The role of non-ulcerative STDs such as gonorrhoeal, chlamydial and trichomonal infections needs further elucidation. Lack of circumcision, traditional healing practices and oral contraceptives may affect the risk of viral transmission, but may not be major or modifiable risk factors. Pregnancy and pregnancy-associated immune alterations do not seem to affect the clinical course of HIV/AIDS in African women or impair immunocompetence. Maternal HIV can adversely affect pregnancy outcome in Africa, causing low birth-weight, prematurity, intrauterine and intrapartum fetal death. The risk for these outcomes is likely to depend on the degree of immunological and clinical deterioration. Breast-feeding does not appreciably increase the risk of HIV transmission to the infant and should be actively promoted in Africa. Control of HIV/AIDS in Africa, in the absence of an effective vaccine, will focus on behavioural changes through health education and condom use. High frequency STD transmitter core groups, mainly prostitutes and their clients, are currently the target of prevention campaigns which are proving to be successful and affordable.

PIP: More than 3 million women are infected with HIV worldwide. Further, 40% of new cases in 1990-91, will be among women. HIV and AIDS are overwhelmingly heterosexually related in Africa and affect similar proportions of both sexes. AIDS may, in fact, be the leading cause of death in some cities, and is thought to be spreading to rural areas through a highly mobile work force, multiple partners, and high rates of sexually transmitted disease (STD). Other biological and behavioral factors also contribute to the existence of the pattern of HIV transmission predominantly seen in Africa. Women and children are at particular risk of infection in African countries. STDs such as chancroid, syphilis, herpes, and gonorrhea; traditional healing practices and sexual behavior; lack of circumcision; and the use of oral contraceptives may all support HIV infection to varying degrees. Of STDs, chancroid, syphilis, and herpes are known to facilitate HIV entry by effecting mucosal discontinuation and recruiting HIV target cells. Pregnancy and pregnancy-associated immunal changes most likely do not affect the clinical course of HIV/AIDS in African women or harm their immune status. Maternal HIV may, however, cause newborns to be of low birth weight or premature, or increase the probability of intrauterine or intrapartum fetal death. Breast feeding does not significantly increase the risk of vertical HIV transmission and should continue to be promoted.