AIDS is one of the leading causes of death of reproductive age women in the United States and is the leading cause of death of Black women of reproductive age in New York and New Jersey. By the end of the decade it will have been responsible for the deaths of several million women worldwide. Despite these statistics, a dearth of information exists regarding the natural history of HIV disease in women. The importance of such information is illustrated by the experience of infected males. Natural history studies were the guideposts which allowed the development of informed biologic and behavioral interventions. By learning the predictive values of CD4 counts, appropriate triggers for therapeutic interventions were devised by studying behaviors, strategies to modify risk were implemented. The success of these strategies is well documented. It is counter-intuitive however, to assume that information garnered predominantly from gay white males would be applicable to populations that vary in gender, race, income and culture. Further, there are gender specific issues that need to be addressed including: 1) the effect of pregnancy, age, drug use and co-infections on HIV disease progression rate, 2) the prevalence, incidence, characteristics and course of HPV infection and anogenital intraepithelial neoplasia among HIV(+) and HIV(-) women and 3) the effect of HIV disease on gynecologic health including infections and reproductive function. In order to address these issues a cohort of approximately 450 HIV(+) women will be recruited and followed for a four year period. Monitoring of clinical and laboratory measures of disease progression and comparison with an extant demographically similar male cohort will allow assessing the first point cited above. Controls for points 2, and 3 will be a cohort of 800 HIV(-) women of similar race and income who are at risk for HIV disease and who are followed on site in an ongoing study.
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