November 19, 1999
To further explore this question, Carpenter et al analyzed data from 264 patients with baseline CD4 counts >500/mm3 and at least 48-weeks of follow-up data. Overall, CD4 counts declined at a rate of 40 cells/yr. In a multivariate analysis, baseline plasma HIV-1 RNA and extent of antiviral use were significant predictors of the the CD4 slope. The rate of CD4 cell loss was not associated with gender in this study regardless of baseline HIV-1 RNA level and regardless of antiretroviral therapy.
Although these results may appear to contrast with those of Farzadegan et al., the are not necessarily contradictory. For example, although this study found similar rates of CD4 cell loss in HIV-infected men and women, it remains possible that women lose CD4 cells at lower virus loads than men. However, Carpenter et al found no significant differences between men and women with regard to virus load. Another possible explanation is that some investigators are studying women soon after infection, whereas other investigators are studying cohorts of infected women with a longer duration of HIV-1 infection. A recent longitudinal study of seroconverters found that although women have lower virus loads than men at the time of seroconversion, these differences become less significant over time. Given the conflicting nature of these reports overall it is premature to suggest gender-specific algorithms for initiation of antiretroviral therapy.