COMPARISON OF THE DECLINES IN CD4 COUNTS IN HIV-1-SEROPOSITIVE FEMALESEX WORKERS AND WOMEN FROM THE GENERAL-POPULATION IN NAIROBI, KENYA

Studies from Kenya have reported rapid clinical disease progression am ong HIV-infected professional sex workers. The reasons for this rapid decline are unknown. To better understand factors influencing the cour se of disease, HIV-1 disease progression was explored in terms of decl ines in CD4 counts. Two samples from Nairobi, Kenya, were studied, one from a cohort of female sex workers and another, as a comparison grou p, from mothers enrolled in an HIV-1 vertical-transmission study. A Ma rkov model was used to analyze transitions between HIV-1 disease stage s as defined by CD4 counts. It appears that sex workers experience a r apid decline in CD4 counts, consistent with earlier findings of rapid clinical disease progression among individuals in this group. The rate of decline in CD4 counts among the mothers appears to be lower. It is speculated that either intensive exposure to sexually transmitted pat hogens or infection with several strains of HIV-1 may account for the rapid disease progression among female sex workers.