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Background: Ethnic differences have the potential to confound associations between HIV-1 subtype and immunologic progression. We compared declines in CD4 cell counts during untreated infection for the most prevalent HIV-1 subtypes, focusing on distinguishing between the effects of viral subtype and ethnicity. Methods: We combined data from 4 European and 6 Canadian cohorts, selecting adults in the stable chronic phase of untreated HIV infection. We estimated the change in square root CD4 cell count over time for subtypes and ethnicities using mixed models, adjusting for covariates selected for their potential effect on initial CD4 cell count or its decline. Results: Data from 9772 patients were analyzed, contributing 79 175 measurements of CD4 cell count and 24 157 person-years of follow-up. Overall, there were no appreciable differences in CD4 cell count decline for viral subtypes A, CRF01_AE, CRF02_AG, C and G compared with viral subtype B; whereas the decline in CD4 cell count in patients of African ancestry was considerably slower than in patients of other ethnicity. When ethnic groups were studied separately, there was evidence for slower declines in CD4 cell count in viral subtypes C, and possibly A and G, compared with viral subtype B in patients of African ancestry but not among patients of other ethnicities, suggesting an interaction between subtype and ethnicity. Interpretation: Ethnicity is a major determinant of CD4 cell count decline; viral subtype differences may have existed but were small compared with the effect of ethnicity and were most apparent in patients of African ancestry. In developing countries, slower CD4 cell count declines among individuals of African descent may translate to a longer asymptomatic phase and increase the opportunity for HIV transmission. [ABSTRACT FROM AUTHOR]

Describes several scenarios for the implementation of the Canadian consensus guidelines for the care of HIV-positive pregnant women. Introduction to the guidelines; Case of an HIV-infected pregnant woman who is not receiving antiretroviral therapy when pregnancy is confirmed; HIV-infected pregnant woman receiving combination antiretroviral therapy when pregnancy is confirmed; Treatment of a woman diagnosed with HIV infection, who presents or is referred for care within 1 month of term.

Presents a summary of consensus guidelines for the care of HIV-positive pregnant women and their offspring, which were developed by the Canadian HIV Trials Network Working Group on Vertical HIV Transmission. General principles on the use of antiretroviral drugs in pregnancy; Discussion on preconception counselling and care; Postpartum care of the woman and the neonate.