Ground zero: AIDS research in Africa

More and more European and North American AIDS researchers are coming to sub-Saharan Africa, which is home to a whopping 70% of all HIV-infected people. These investigators are collaborating with local researchers on projects that aim to slow both HIV's spread and the course of disease in the millions already infected. But most African countries--constrained by limited resources, weak infrastructures, social mores, and political inaction--have grave difficulties translating research insights into prevention and treatment strategies.     

Drug-resistant Salmonella in the United States: an epidemiologic perspective

Salmonellosis poses a health problem of large proportions in the United States. Annually, it accounts for more than 40,000 reported cases, 500 deaths, and financial costs well in excess of $50 million. Antimicrobial resistance is increasing in Salmonella strains, a finding that has important public health implications. Although the chain of transmission of the bacteria is often complex, combined epidemiologic and laboratory studies with the use of new methods in molecular biology make it possible to trace antimicrobial-resistant salmonellae to their primary source--foods of animal origin. These studies suggest that the antimicrobial drugs to which food animals are exposed provide selective pressure that leads to the appearance and persistence of resistant strains.     

AIDS: an international perspective

The acquired immunodeficiency syndrome (AIDS) and infection with the human immunodeficiency virus type 1 (HIV-1) constitute a worldwide public health problem. Whereas in Europe and in most of the Americas transmission of HIV-1 has occurred predominantly among homosexual men and intravenous drug abusers, in Africa a distinct epidemiologic pattern has emerged that indicates that HIV-1 infection is mainly heterosexually acquired. Heterosexual transmission appears to be increasing in some parts of Latin America and the Caribbean, and possibly in the United States. In addition to HIV-1, at least one other human retrovirus, namely HIV-2, has been implicated as a cause of AIDS in Africa and Europe. Factors that influence heterosexual transmission of HIV-1 include genital ulcerations, early or late stages of HIV-1 infection in the index case, and possibly oral contraception and immune activation. The rate of perinatal transmission is enhanced when the mother's illness is more advanced. AIDS and HIV-1 infection may have a significant impact not only on public health, but also on the demography and socioeconomic conditions of some developing countries. Programs for the prevention and control of AIDS should be an immediate priority in all countries.     

Africa boosts AIDS vaccine R&D

Efforts have recently heated up in several African countries to tailor-make preparations that many believe offer the best hope yet for stopping HIV cold. But all are at the earliest stages, which means it will take years before a vaccine might prove its worth.     

HIV/AIDS in women: an expanding epidemic

More than 20 years into the human immunodeficiency virus-type 1 (HIV-1) epidemic, women account for nearly half of the 40 million people living with HIV-1 worldwide, with an even higher proportion existing in developing countries. Social determinants of female vulnerability to HIV-1 include gender disparities, poverty, cultural and sexual norms, lack of education, and violence. Women are also more susceptible to HIV-1 because of hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases. Prevention strategies must address the wide range of gender inequalities that promote the dissemination of HIV-1.     

Toward an AIDS vaccine

A quarter century of scientific discovery has been applied to developing an AIDS vaccine, yet this goal remains elusive. Specific characteristics of the virus, including the extreme genetic variability in circulating viral isolates worldwide, biological properties of HIV that impede immune attack, and a high mutation rate that allows for rapid escape from adaptive immune responses, render this a huge challenge. However, evidence of protection against AIDS viruses in animal models and control of HIV in humans under certain circumstances, together with scientific advances in understanding disease pathogenesis, provide a strong rationale and objective paths to continue the pursuit of an effective AIDS vaccine to stem the global epidemic.