Improved understanding of factors which affect infectivity of women may lead to development of preventive interventions for heterosexual and perinatal transmission. The major goal of this project is to define the prevalence, quantity, and correlates of HIV DNA and RNA in cervical and vaginal secretions of HIV seropositive women. A cross-sectional study of 400 prostitutes in Mombasa, Kenya will be conducted to evaluate the association between genital mucosal HIV and CD4 level, hormonal contraception, pregnancy, cervical ectopy, sexually-transmitted diseases, local inflammation, pH, estradiol, progesterone, and vitamin A. In addition, three substudies will be conducted. In the first, 300 women with Neisseria gonorrhoeae, Chlamydia trachomatis, Trichmonas vaginalis, Candida ssp., or bacterial vaginosis (and, in particular, absence of hydrogen peroxide producing lactobacilli) will be evaluated before and after treatment of the genital infection to document reduction in HIV shedding following resolution of sexually-transmitted diseases. In the second, 60 women will be studied before and after institution of hormonal contraception with either oral contraceptive pills or injectable progesterone to determine whether method of contraception has a measurable effect on HIV shedding. In the third, a group of 10 women will be evaluated daily for one month to define the pattern of cervical and vaginal HIV and HIV specific antibodies in relation to menstrual cycle. In this proposed study the researchers will characterize factors which affect HIV infectivity in women and may lead to new intervention strategies to prevent transmission.
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