Sex, microbial translocation, and the African HIV epidemic

Redd et al. (1) suggest that microbial translocation is not an important contributor to HIV disease progression in Africa, in contrast to its possible role in HIV pathogenesis in North American cohorts (2–4). They further postulate that this discrepancy may relate to mode of HIV transmission, because the Ugandan cohort in which they base their study is composed of heterosexual men and women, whereas North American cohorts typically contain more men who have sex with men and injection drug users. These conclusions are based on a study in which they prospectively examined whether plasma markers of microbial translocation correlated with HIV progression and found that they did not. However, we suggest that these data are not sufficient to conclude that microbial translocation is not an important contributor to HIV disease in Africa.