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African HIV-1 epidemic probably not caused by more virulent viral subtypes
Last Updated: 2001-04-16 14:44:59 EDT (Reuters Health)
By Anthony J. Brown, MD
WESTPORT, CT (Reuters) - High viral load and genital ulceration appear to be responsible for the high rate of HIV-1 sexual transmission in Uganda, rather than a greater virulence of the A and D viral subtypes that predominate in the region.
In a study reported in the April 14th issue of The Lancet, Dr. Ronald H. Gray, from the Johns Hopkins University in Baltimore, and colleagues assessed the factors that influence the sexual transmission of HIV-1 in 174 serodiscordant, monogamous couples in Rakai, Uganda. Data were collected from November 1994 through October 1998.
On average, couples had sexual intercourse 8.9 times per month, but this number decreased with age and HIV-1 viral load, the authors state. Per coital act, the overall unadjusted risk of HIV-1 transmission was 0.0011.
The risk of transmission increased significantly when higher viral loads and genital ulceration were present. The risk of infection, however, was not influenced by the presence of viral subtypes A and D, sex of the infected partner, the presence of sexually transmitted diseases, or symptoms of discharge or dysuria in the infected partner.
"The infectivity of the virus in Africa is comparable to what we see in Europe and North America," Dr. Gray said in a telephone interview. "We are not dealing with a nastier virus, we are dealing with the social, cultural and political context."
Dr. Gray noted that "the one place where the infectivity of the virus may be important is in West Africa." The infection rate in West Africa is less explosive than in other areas of the continent. The researchers believe that could be because the region has more recombinant HIV viruses, rather than a clear subtype. Research by Dr. Gray's team and others suggest that recombinant viruses are less infectious.
"Scientifically, the evidence that the HIV viral load is a critical determinant is of very profound importance for further control strategies. That has not been shown before," Dr. Gray said. Antiretroviral drugs that reduce the level of the virus in the body could help to reduce infectivity, he added.
Lancet 2001;357:1149-1153.
-Westport Newsroom 203 319 2700
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Copyright 2001 Reuters Limited. All rights reserved. Republication or redistribution of Reuters Limited content, including by framing or similar means, is expressly prohibited without prior written consent of Reuters Limited. Reuters Limited shall not be liable for any error or delays in the content, or for any actions taken in reliance thereon.
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