Minerva

Research in Thailand may have helped explain why HIV infection seems to be transmitted by heterosexual sex more commonly in Africa and Asia than in Europe and North America (Science 1995;270:30-1). The strain of HIV known as subtype E, which predominates in Asia, multiplies readily in the Langerhans' cells of the vagina, whereas the subtype B found in the United States grows far less readily in these cells. Some of the epidemiological data are inconsistent with this explanation, but the predominance of different types of HIV in different parts of the world seems well established.

Cholestasis of pregnancy is associated with a high morbidity and mortality among affected fetuses. A report in “Gut” (1995;37:380-4) describes eight women referred to the Birmingham liver unit who had had 13 pregnancies complicated by cholestasis: eight of the pregnancies had ended in stillbirths, two in premature deliveries with one neonatal death, and one in an emergency caesarean delivery. Three of these women developed cholestasis in a further pregnancy and were treated with ursodeoxycholic acid: their pruritus resolved, their liver function returned to normal, and all three gave birth to healthy infants.

Women who postpone having their children until well past the age of 30 know that their fertility declines with age. Traditionally the …