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A cohort study conducted in Kigali Rwanda in 1992-93 investigated the effect of chorioamnionitis (CAM) on pregnancy outcomes in HIV-positive pregnant women after controlling for common STDs. All pregnant women attending the prenatal clinic at the Centre Hospitalier de Kigali at 24-28 weeks gestation were offered voluntary HIV testing and STD screening. A total of 286 HIV-positive and 275 HIV-negative women were enrolled and received monthly clinical follow-up with treatment for STDs and conditions such as anemia when needed. At enrollment the two groups did not differ in terms of STD prevalence. On the basis of histologic examination of the placenta CAM was diagnosed in 27 HIV-positive women (9.8%) and 28 HIV-negative women (9.8%). Independent of HIV status there were no significant associations between CAM and age parity hepatitis B anemia STDs and CD4 lymphocyte count. Among HIV-negative women CAM was significantly associated with prematurity (relative risk (RR) 3.0; 95% confidence interval (CI) 1.5-6.3) stillbirth (RR. 4.2; 95% CI 1.6-11.0) and premature rupture of the membranes (RR 2.9; 95% CI 1.4-6.1). Among HIV-positive women the only adverse outcome significantly associated with CAM was early neonatal mortality (RR 2.0; 95% CI 1.6-11.0). The unexpectedly low rate of CAM recorded in this study is probably a result of the STD treatment and other medical services offered to study participants. This in turn suggests that control of STDs and anemia during pregnancy may represent a feasible intervention for reducing vertical HIV transmission in developing countries. Further microbiologic and histologic studies are recommended to elucidate the physiopathology of CAM in HIV-infected women during pregnancy.

The effect of antenatal services including malaria and sexually transmitted disease (STD) treatment on pregnancy outcome was evaluated in HIV-positive women recruited in the last 3 months of pregnancy from the antenatal ward of the Centre Hospitalier de Kigali Rwanda in 1992-93. Until delivery these 384 HIV-infected women and 381 age- and parity-matched HIV-negative controls from the same facility received monthly malaria and STD diagnosis and treatment. At least one STD was diagnosed in the study period in 144 cases (39.6%) and 100 controls (27.4%); the malaria rates were 20.9% and 15.9% respectively. Maternal and neonatal outcomes at delivery and at 6 weeks postpartum were also compared. There were 10 stillbirths among HIV-positive women (2.7%) and 8 (2.2%) among controls. Excluding twins (n = 14) 22.7% of infants born to HIV-positive women compared with 14.1% of those born to HIV-negative controls were premature (

The efficacy of infant peri-exposure prophylaxis (PreP) to prevent HIV-1 postnatal transmission has never been assessed for the entirerecommended period of breastfeeding (12 months).The ANRS 12174 study is a randomised controlled trial comparing the efficacy and safety of lopinavir/ritonavir versus lamivudine to preventHIV-1 postnatal transmission in breastfeeding children born to HIV-1-infected mothers not eligible for ART (CD4 count above 350cells/mL) during breastfeeding (maximum 50 weeks). HIV-uninfected children aged 7 days were randomised for either drug in a 1:1 ratio.Infant HIV-infection status was assessed at week 6, 14, 26, 38 and 50 using HIV-1 DNA PCR. The study has completed enrolment in April2012 in Burkina Faso, Uganda, Zambia and South Africa. We report the current postnatal HIV-1 transmission rate and HIV-1 free survivalin the cohort among children aged 50 weeks or more in July 2012.By the end of July 2012, of 1273 children enrolled in the trial, 788 were aged 50 weeks or older. During this period, 8 transmissions occurredrepresenting a cumulative transmission rate of 1.1% (95%CI: 0.6-2.2). Interestingly, 6/8 transmissions occurred after 6 months ofbreastfeeding. Overall, 188 severe adverse events (grade 3 or more, DAIDS classification) and 22 deaths were identified. None were consideredattributable to the study drugs. The overall cumulative mortality was 3.0% (95%CI: 2.0-4.5) and HIV-1-free survival was 96.0%(95%CI: 94.3-97.2).Infant PreP is an efficacious strategy that could contribute to the elimination of HIV-1 transmission by breastfeeding.

This study sought to identify the factors associated with failure to return for HIV post-test counseling in pregnant women in Kigali (Rwanda). In the context of a study on the impact of HIV infection on pregnancy HIV-1-antibody testing was offered to all pregnant women attending the antenatal clinic of the Centre Hospitalier de Kigali from July 1992 to August 1993. Pre-test counseling was performed after verbal informed consent was obtained. Two weeks later the authors formally enrolled all HIV-positive women and a corresponding number of HIV-negative women in a cohort. At this visit post-test counseling was given to those wishing to be informed of their HIV serostatus. Level of knowledge about modes of HIV transmission and condom use were recorded. Four months after delivery another interview was conducted to determine the proportion of women who used condoms regularly. A total of 1233 pregnant women were screened. The HIV seroprevalence was 34.4% (95% confidence interval [CI] 31.7-37.1); 271 (63.9%) out of 424 HIV-positive and 577 (71.3%) out of 809 HIV-negative women asked for their HIV serostatus (p = 0.008). In multivariate analysis the only variable significantly associated with failure to return for post-test counseling was a positive HIV test result (odds ratio 0.7; 95% CI 0.5-0.9; p = 0.009) independently of obstetrical history and socioeconomic characteristics. Among the 848 women who had post-test counseling 50.9% of the HIV-positive women and 94.6% of the HIV-negative women stated that they planned to inform their partner of their serostatus (p = 0.0001). More than 95% of the women interviewed knew about sexual and parenteral transmission of HIV but half were unaware of mother-to-child transmission. More than 80% of the women had seen a condom before but 14% only had used it at least once. Among women who were sexually active four months after delivery 8.8% of the HIV-positive and 3.9% of the HIV-negative women reported using a condom (p = 0.04). Innovative approaches for HIV testing and counseling programs are needed and the importance of psychosocial and cultural factors associated with HIV testing should be emphasized in African populations. (authors)

Background. Antiretroviral (ARV) prophylaxis effectively reduces mother-to-child transmission of human immunodeficiency virus type 1 (HIV). However, it is unclear whether stopping ARVs after breastfeeding cessation affects maternal HIV disease progression. We assessed 18-24-month postpartum disease progression risk among women in a randomized trial assessing efficacy and safety of prophylactic maternal ARVs. Methods. From 2005 to 2008, HIV-infected pregnant women with CD4(+) counts of 200-500/mm(3) were randomized to receive either triple ARV (zidovudine, lamivudine, and lopinavir/ritonavir during pregnancy and breastfeeding) or AZT/sdNVP (zidovudine until delivery with single-dose nevirapine without postpartum prophylaxis). Maternal disease progression was defined as the combined endpoint of death, World Health Organization clinical stage 4 disease, or CD4(+) counts of = 350/mm(3) progressed. Conclusions. Interrupting prolonged triple ARV prophylaxis had no effect on HIV progression following cessation (compared with AZT/sdNVP). However, women on triple ARV prophylaxis had lower progression risk during the time on triple ARV. Given the high rate of progression among women with CD4(+) cells of

Background: Human papillomaviruses are the most common sexually transmitted infections, and genital warts, caused by HPV-6 and 11, entail considerable morbidity and cost. The natural history of genital warts in relation to HIV-1 infection has not been described in African women. We examined risk factors for genital warts in a cohort of high-risk women in Burkina Faso, in order to further describe their epidemiology. Methods: A prospective study of 765 high-risk women who were followed at 4-monthly intervals for 27 months in Burkina Faso. Logistic and Cox regression were used to identify factors associated with prevalent, incident and persistent genital warts, including HIV-1 serostatus, CD4+ count, and concurrent sexually transmitted infections. In a subset of 306 women, cervical HPV DNA was tested at enrolment. Results: Genital wart prevalence at baseline was 1.6% (8/492) among HIV-uninfected and 7.0% (19/273) among HIV-1 seropositive women. Forty women (5.2%) experienced at least one incident GW episode. Incidence was 1.1 per 100 person-years among HIV-uninfected women, 7.4 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count >200 cells/mu L and 14.6 per 100 person-years among HIV-1 seropositive women with a nadir CD4+ count

We examined factors associated with perceived risk of AIDS, behavior change, and HIV infection in a representative sample of 1458 child-bearing urban women in Rwanda, central Africa. Although 68% of women reported only one lifetime partner, and the majority (87%) lived with a husband or steady partner, the prevalence of HIV antibodies was still high (32%). Before receiving their HIV test results, the women completed a questionnaire about AIDS knowledge, attitudes, and practices. Knowledge about HIV transmission was high, with 96-98% of women correctly identifying the three primary routes of infection. However, only 16% of women reported taking any action to avoid AIDS in the previous year, and most (11%) had done so merely by asking their male partners to change their behavior. Only 7% of women had ever tried condoms, and many (68%) thought they could be dangerous to use. Women who perceived themselves at risk of AIDS (57%) were more likely to report changing behavior; they were also more likely to be infected with HIV. Other factors associated with behavior change included having known someone with AIDS, having discussed AIDS with a male partner, and believing that condoms are not dangerous. Future interventions should enhance perception of risk, encourage male sexual partners to reduce risky behavior, and increase familiarity with condoms.The authors examined factors associated with perceived risk of AIDS, behavior change, and HIV infection in a representative sample of 1458 childbearing urban women in Rwanda, central Africa. Although 68% of them reported only 1 lifetime partner, and the majority (87%) lived with a husband or steady partner, the prevalence of HIV antibodies was still high (32%). Prior to receiving their HIV test results, the women completed a questionnaire about AIDS knowledge, attitudes, and practices. Knowledge about HIV transmission was high, with 96-98% of women correctly identifying the 3 primary routes of infection. However, only 16% reported taking any action to prevent AIDS in the previous year, and most (11%) had done so merely by asking their male partners to change their behavior. Only 7% of the women has ever tried condoms, and many (68%) thought they could by dangerous to use. Those women who perceived themselves at risk for AIDS (57%0 were more likely to report changing behavior; they were also more likely to be HIV-infected. Other factors associated with behavior change included having known someone with AIDS, having discussed AIDS with a male partners, and believing that condoms are not dangerous. Future interventions should enhance the perception of risk, should encourage male sexual partners to reduce risktaking behavior, and should increase familiarity with condoms.

Human papillomavirus (HPV) infection and cervical squamous intraepithelial lesions (SILs) were studied in 379 high-risk women. Human papillomavirus DNA was detected in 238 of 360 (66.1%) of the beta-globin-positive cervical samples, and 467 HPV isolates belonging to 35 types were identified. Multiple (2-7 types) HPV infections were observed in 52.9% of HPV-infected women. The most prevalent HPV types were HPV-52 (14.7%), HPV-35 (9.4%), HPV-58 (9.4%), HPV-51 (8.6%), HPV-16 (7.8%), HPV-31 (7.5%), HPV-53 (6.7%), and HPV-18 (6.4%). Human immunodeficiency virus type 1 (HIV-1) seroprevalence was 36.0%. Human papillomavirus prevalence was significantly higher in HIV-1-infected women (87 vs 54%, prevalence ratio (PR) = 1.61, 95% confidence interval (CI): 1.4-1.8). High-risk HPV types (71 vs 40%, PR = 1.79, 95% CI: 1.5-2.2), in particular HPV-16+18 (22 vs 9%, PR = 2.35, 95% CI: 1.4-4.0), and multiple HPV infections (56 vs 23%, PR = 2.45, 95% CI: 1.8-3.3) were more prevalent in HIV-1-infected women. High-grade SIL (HSIL) was identified in 3.8% of the women. Human immunodeficiency virus type 1 infection was strongly associated with presence of HSIL (adjusted odds ratio = 17.0; 95% CI 2.2-134.1, P = 0.007) after controlling for high-risk HPV infection and other risk factors for HSIL. Nine of 14 (63%) HSIL cases were associated with HPV-16 or HPV-18 infection, and might have been prevented by an effective HPV-16/18 vaccine.

To investigate the potential acceptability of interventions intended to reduce mother-to-child transmission of human immunodeficiency virus (HIV)-1 in West Africa a pilot study was conducted among 607 pregnant women at maternal-child health centers in Abidjan (Ivory Coast) and Bobo-Dioulasso (Burkina Faso). 81-95% of women interviewed at the 4 sites accepted the principle of an HIV screening test and 92-97% indicated they would want to know the results. However 64-91% stated they would need the consent of their partner before testing. In the event of a positive test result most women were agreeable to participation in an intervention (i.e. oral tablets vaginal suppositories both tablets and suppositories) aimed at reducing the risk of HIV-1 transmission to their infant. The option chosen by the most women varied according to study site. Finally when the concept of a double-blind randomized placebo-controlled clinical trial was explained by a social worker to women at the 2 sites in Bobo-Dioulasso 87% and 90% found this acceptable. Although these results do not necessarily predict the actual behaviors of pregnant women in a situation to be enrolled in clinical trials the results are sufficiently promising to suggest that affordable sustainable and appropriate interventions for reducing maternal transmission of HIV-1 should be evaluated in Africa.

Position du problème : En raison de l'influence de l'infection à VIH sur la fertilité, sa prévalence estimée dans les dispensaires prénatals par la surveillance sentinelle peut ne pas refléter la réalité de l'infection dans la population générale. L'objectif de notre travail était d'évaluer l'impact de l'infection à VIH sur la fertilité chez des femmes enceintes à Bobo-Dioulasso (Burkina Faso) afin de discuter des implications possibles sur la surveillance sentinelle. Méthodes : Dans le cadre d'un essai thérapeutique de réduction de la transmission mère-enfant du VIH par la zidovudine (essai ANRS 049), nous avons proposé le test VIH à 1 349 femmes âgées de 18 ans et plus, enceintes d'au moins 7 mois et résidant dans les limites territoriales de Bobo-Dioulasso. A l'occasion de la séance individuelle de conseil pré-test, un questionnaire standardisé leur a été administré pour receuillir des informations détaillées sur leur histoire obstétricale et leurs caractéristiques démographiques. Des échantillons de sang ont été collectés et testés pour le VIH après obtention d'un consentement écrit. Résultats : L'âge moyen (+ ou - ecart-type) au moment des premiers rapports sexuels était similaire chez les femmes infectées par le VIH-1 (VIH+) (16,7 ans + ou - 2, n = 83) et chez celles non-infectées (VIH-) (16,9 ans + ou - 2, n = 1 136) que celles VIH- (5,0 + ou - 2,3, n = 35) que celles VIH- (3,7 + ou - 2, n = 555), p = 0.02. Les 2 groupes de femmes étaient comparables pour les autres caractéristiques de leur histoire obstétricale, à savoir l'âge à la grossesse actuelle, la proportion de primigestes, le nombre moyen de mort-nés et celui d'avortement spontanés. Conclusions : Nos données suggèrent que le niveau de fertilité des femmes VIH+ âgées de 25 ans et plus est inférieur à celui des femmes VIH-... (D'après résumé d'auteur)

Reported are the results of a cross-sectional survey in Burkina Faso to identify reliable, practical strategies for the serological diagnosis of HIV-1 and/or HIV-2 infections, using less-expensive commercial test kits in various combinations, as an alternative to the conventional Western blot (WB) test, which costs US$ 60. Serum samples, collected from blood donors, patients with acquired immunodeficiency syndrome (AIDS) and pregnant women, were tested between December 1995 and January 1997. Twelve commercial test kits were available: five Mixt enzyme-linked immunosorbent assays (ELISA), three Mixt rapid tests, and four additional tests including monospecific HIV-1 and HIV-2 ELISA. The reference strategy utilized a combination of one ELISA or one rapid test with WB, and was conducted following WHO criteria. A total of 768 serum samples were tested; 35 were indeterminate and excluded from the analysis. Seroprevalence of HIV in the remaining 733 sera was found to be 37.5% (95% confidence interval: 34.0-41.1). All the ELISA tests showed 100% sensitivity, but their specificities ranged from 81.4% to 100%. GLA (Genelavia Mixt) had the highest positive delta value, while ICE HIV-1.0.2 (ICE) produced the most distinct negative results. Among the rapid tests, COM (CombAIDS-RS) achieved 100% sensitivity and SPO (HIV Spot) 100% specificity. Various combinations of commercial tests, according to recommended WHO strategies I, II, III, gave excellent results when ICE was included in the sequence. The best combination of tests for strategy II, which achieved 100% sensitivity and specificity, was to use ICE and COM, the cost of which was US$ 2.10, compared with US$ 55.60 for the corresponding conventional strategy. For strategy III, the best combination, which achieved 100% sensitivity and specificity, was to use ICE, ZYG (Enzygnost Anti HIV-1/HIV-2 Plus) and COM, the cost of which was US$ 2.90 (19.2 times lower than the corresponding strategy requiring WB). No rapid test combination showed 100% sensitivity and specificity. Our results indicate that the serodiagnosis of HIV in Burkina Faso is possible by using reliable, less-expensive strategies which do not require Western blot testing. Moreover, there is a choice of strategies for laboratories working with or without an ELISA chain.

Objective : to study the relationship between human immunodeficiency virus (HIV) infection and body weight in African women during and after pregnancy. Methods : a prospective cohort study was initiated at the Centre Hospitalier de Kigali in July 1992. Every woman seen at the antenatal clinic and with a gestational age of less than 28 weeks was offered HIV-1 antibody testing. Comparable numbers of HIV-infected (HIV+) and uninfected (HIV-) women were recruited. At inclusion, socio-demographic characteristics and self-reported pre-pregnancy weight were recorded ; height and weight were measured. Each woman enrolled had a monthly follow-up until 9 months after delivery, with a clinical examination including weighing. Three anthropometric indices were used to answer the study objectives : weight body mass index (BMI), and pregnancy balance. Results : as of April 1994, 101 HIV+ and 106 HIV- women were followed until 5 months after delivery. Weight and BMI during pregnancy were lower in HIV+ women than in HIV- women. After delivery, weight and BMI gains were significantly lower in HIV+ women. Until 5 months after delivery, the mean weight variation was -2.2 kg (standard deviation (SD) = 5.9 kg) in HIV+ women and +0.2 kg (SD = 6.6 kg) in HIV- women (P = 0.007) in comparison to pre-pregnancy weight. Comparisons of the slopes of the weight curves did not show statistical differences throughout the pregnancy, but it did during the post-partum period (P = 0.02). Conclusions : our study suggests that HIV infection could impair nutritional status in pregnant women, especially during the post-partum period. Family planning and maternal and child health services including HIV testing and counselling, should consider a nutritional assessment and intervention programme targeted to HIV+ pregnant women. (Résumé d'auteur)

La transmission de la mère à l'enfant du virus de l'immunodéficience humaine (VIH) est la cause majeure de l'extension à la population pédiatrique de l'épidémie d'infection par le VIH. Depuis le début de la pandémie, trois millions d'enfants de par le monde seraient nés infectés par le VIH. Le poids que supportent les pays en développement dans cette épidémie est considérable puisque de 90 à 95% des femmes susceptibles de transmettre à leurs enfants le VIH vivent dans ces régions. Aussi, la prévention de la transmission de la mère à l'enfant du VIH doit être élevée à un rang de priorité dans ces pays. Dans les pays industrialisés, le traitement antirétroviral par l'azidothymidine (AZT), assorti de la suppresssion de l'allaitement au sein des nouveau-nés, a prouvé son efficacité pour réduire cette transmission. Mais plusieurs obstacles empêchent d'appliquer automatiquement ces méthodes dans les pays en développement : la complexité de la stratégie thérapeutique expérimentée ; la lourdeur de la logistique à mobiliser ; le coût global rédhibitoire ; le danger que constitue la suppression de l'allaitement au sein des enfants ; l'ignorance de l'efficacité du traitement par l'AZT dans une population où l'allaitement maternel est général et où circulent d'autres sous-types de VIH ; l'appréhension de la population générale pour les questions relatives à l'infection par le VIH ; la prévalence élevée de l'anémie maternelle. Il apparaît clairement que les interventions capables d'avoir un impact décisif dans la réduction de la transmission de la mère à l'enfant du VIH sont celles qui seraient applicables dans le système actuel des structures de santé et qui seraient sûres, acceptables, efficaces et d'un coût abordable. Trois d'entre elles ont ce potentiel : le traitement de la mère par des drogues antirétrovirales selon un schéma court couvrant la période périnatale ; la désinfection, pendant la période périnatale, de la filière génitale par des antiseptiques virulicides ; la supplémentation en vitamine A des femmes enceintes et des enfants... (D'après résumé d'auteur)

To estimate the seroincidence of HIV-1 infection among women of reproductive age in Kigali, Rwanda.Fixed prospective cohort followed for 36 months between November 1988 and June 1992, as part of an ongoing study of mother-to-child transmission of HIV-1.Centre Hospitalier, Kigali, Rwanda.A total of 216 HIV-seronegative women were enrolled at delivery between November 1988 and June 1989.A blood sample was obtained at delivery to test for HIV antibodies (by enzyme-linked immunosorbent assay and Western blot). Serum was tested every 3 months during follow-up. Incidence density rates of HIV seroconversion were estimated.The follow-up rate after 3 years was 89%, assessed by the maximum person-years method. The seroincidence density rate was 3.5 per 100 women-years (95% confidence interval, 1.9-5.0). It decreased linearly from 7.6 during the first 6-months postpartum to 2.5 per 100 women-years during the last 6 months of the third year of follow-up. Maternal age did not affect HIV incidence rates. We examined the role of the cohort, counselling, and the first 6-month postpartum effects on this estimate.This fixed cohort provided an overall estimation of the HIV infection incidence rate and its dynamics. These figures could be used for programming future HIV preventive vaccine efficacy trials in Rwanda.The objective was to estimate the seroincidence of HIV-1 infection among women of reproductive age in Kigali, Rwanda. A fixed prospective cohort followed a total of 216 HIV-seronegative women for 36 months between November 1988 and June 1992 at Centre Hospitalier, Kigali, Rwanda. A study of mother-to-child transmission of HIV-1 has been going on at the Centre Hospitalier de Kigali since November 1988. A group of HIV-seronegative women matched by maternal age and parity was consecutively selected as a comparison group. The mean maternal age was 25.1 years (SD, 4.5 years), and the total number of pregnancies was 2.7 (SD, 1.8). A blood sample was obtained at delivery to test for HIV antibodies (by enzyme-linked immunosorbent assay and Western blot). Serum was tested every 3 months during follow-up. The follow-up rate after 3 years was 89.2% (577/646.75), assessed by the maximum person-years method. 20 seroconversions were documented during the first 36 months of follow-up among the 216 women seronegative at inclusion, yielding a cumulative incidence of 11.2%. The largest number of seroconversions (8/20; 40%) was observed in the first 6 months of the postpartum period. The seroincidence density rate was 3.5/100 women-years (95% confidence interval, 1.9-5.0). It decreased linearly from 7.6 during the first 6-months postpartum to 2.5 per 100 women-years during the last 6 months of the third year of follow-up (P = 0.01). Maternal age did not affect HIV incidence rates. We examined the role of the cohort, counseling, and the first 6-month postpartum effects on this estimate. The study confirms that pregnant women may represent a population in which the HIV seroincidence is high and concentrated in the immediate postpartum period. Pregnant women should become a potential target group for future large scale vaccination trials and programs with adequate follow-up. These figures could be used for programming future HIV preventive vaccine efficacy trials in Rwanda.

To determine if beta 2-microglobulin (beta 2M) predicts death among HIV-infected African women.Nested case-control study.Kigali, Rwanda.Two hundred and five seroprevalent women known to be HIV-infected since 1986-1987; 67 of whom died of HIV disease (cases) and 138 were alive (controls) as of November 1991. In addition, 128 women who seroconverted between 1986 and 1991.HIV serology, clinical signs and symptoms of HIV disease, hematology variables, and beta 2M concentration.beta 2M concentration increased over time (P0.001) in the seroprevalent women and seroconvertors. The average rate of beta 2M increase in women who died was 0.5 compared with 0.3 mg/l/year in the vital, seroprevalent women (P = 0.07). The strongest independent predictors of death were the rate of change of beta 2M (mg/l/year) [odds ratio (OR), 3.4; 95% confidence interval (CI), 1.7-6.8] and baseline beta 2M concentration (mg/l) [OR, 1.6; 95% CI, 1.2-2.1]. The rate of death for women with beta 2M concentrationor = 7.0 mg/l and a rate of change of beta 2Mor = 0.4 mg/l/year was 7.3 times higher than for women with beta 2M concentration7.0 mg/l and a rate of change of beta 2M of0.4 mg/l/year (95% CI, 3.1-17.2). The estimated median time from seroconversion to death assuming a constant rate of change of beta 2M was 10.6 years (95% CI, 9.9-11.2) for this cohort of HIV-infected women.Elevated beta 2M and a high rate of beta 2M increase were strongly associated with mortality among HIV-infected African women. Based on survival estimates using the rate of change of beta 2M, HIV-infected African women have similar survival compared with HIV-infected adults in the United States.