HIV/AIDS Therapy: No "Substantial" Difference Found in Antiretroviral Therapy Benefit by Gender

Amsterdam researchers M. Prins and colleagues of the Municipal Health Service found that the beneficial effects of antiretroviral (ARV) therapy do not differ between the sexes.

The investigators "reviewed the available literature on the potential effects of sex on the course of HIV infection and found that there is little evidence for sex differences in the rate of disease progression" in the pre-highly active antiretroviral therapy (HAART) and HAART era, according to the study.

"Compared to men, women appeared to have lower HIV RNA levels and higher CD4 cell counts shortly after infection with HIV, but studies were inconclusive regarding whether these differences diminish over time. Differences in viral load or CD4+ cell count might cause women to delay initiation of HAART. Nonetheless, we found no substantial sex difference in the benefit of antiretroviral therapy," the authors reported.

"The studies we reviewed failed to find any harmful effect of pregnancy on HIV disease progression. With the availability of effective antiretroviral agents, HIV infected women have increasingly decided to have children," the report stated.

"Conflicting results exist on the effect of HAART on regression of cervical intraepithelial neoplasia (CIN)," Prins and colleagues found. "Unlike CIN, invasive cervical cancer has not been found to be much higher in HIV infected women than in HIV uninfected women. Although publication bias cannot be ruled out, published studies suggest higher rates of adverse events among HIV infected women on therapy as compared to men."

Prins and coauthors noted, "As more pharmacological agents are developed, it is especially important that potential sex differences in pharmacodynamics are assessed. The relationship between metabolic abnormalities, changes in body habitus, and endocrine perturbations has not been extensively studied. Whether sex differences are due to unalterable genetic factors or social and environmental conditions, it is imperative that all HIV infected individuals have equal access to interventions that can slow disease progression."

The study, "Sex and the Course of HIV Infection in the Pre-and Highly Active Antiretroviral Therapy Eras," was published in AIDS (2005;19(4):357-370).

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