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The Body Covers: The 35th Annual Meeting of the Infectious Diseases Society of America

Are There Gender Differences in HIV Disease Progression?

Coverage provided by Daniel Kuritzkes, M.D.

November 19, 1999

One of the more surprising findings of the last two years was the observation by Farzadegan et al that HIV-infected women had lower plasma virus RNA levels than men, even after controlling for CD4 count {Farzadegan, Hoover, et al. 1998 ID: 1739} . The implication of these data was that women might experience more rapid disease progression, with lower virus loads leading to greater depletion of CD4 cells than had been observed in men with similar virus loads. The biological basis for these observations is poorly understood.

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.




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