More data are becoming available that support earlier reports of gender differences in viral load (WISE Words #3). In addition, two new findings that add dimension to this emerging picture were presented at the recent Women and AIDS conference.
First, women with a history of injection drug use had significantly lower viral levels than women who hadn't used injection drugs. More research is needed to determine the cause of this difference. It could be due to a variety of factors, including (but not limited to) issues around modes of HIV infection (e.g. sexually or directly into the blood through the vein) or lifestyle factors linked to a history of intravenous drug use.
Second, when comparing race-ethnic groups within the study, women of color had significantly lower viral loads than white women. These findings are contrary to another study that found viral loads among African Americans were higher than whites. Nevertheless, the possibility of racial or ethnic differences in viral load and disease progression may exist and needs further study.
Do Women Respond Better to Anti-HIV Therapy?
Another study reports there may be gender differences in CD4+ cell count responses after beginning combination anti-HIV therapy. In this study, after eight months of therapy, the average increase in CD4+ cell count was greater among women than men (34% vs. 26% increase). These results were not explained by either CD4+ cell counts or viral loads at start of therapy. Further study is needed to determine if immune recovery (noted by increased CD4+ cell count) is different between women and men.
Do Hormonal Contraceptives Affect Viral Levels?
Hormonal contraceptives do not appear to affect viral load in women, according to the Women's Interagency HIV Study. The study compared HIV levels in women using hormonal contraceptives (i.e. oral contraceptives, injectable Depo-Provera® or Norplant®) to women not taking them. After 20 months, no differences were found between the two groups. In addition, there was no connection between viral load changes and the type of hormonal contraception used.
These results may ease some women's concerns about using hormonal contraceptives. However, unanswered questions still remain about the interaction of hormonal contraceptives with particular anti-HIV therapies and HIV disease itself.
Testosterone Therapy in Women with Wasting, Loss of Periods
Women naturally produce testosterone. However, women with AIDS-related wasting (weight loss without a clear cause) have lower than normal levels of it. A break or decline in the frequency of menstruation is one of many symptoms connected with AIDS wasting in women.
Results from one study suggest that women who receive a replacement dose of testosterone (a dose that brings the hormone to a normal level in blood) experienced weight gain, return of menstruation and improved quality of life. Testosterone replacement was well-tolerated, and no negative effects occurred on lipid levels or liver function tests. However, more studies are needed to measure the effects and safety of testosterone use in HIV-infected women, particularly as a possible means to manage lipodystrophy and menstrual disorders.
Unique Issues Among Older Women
An increasing number of "older women" are becoming infected with HIV. At the same time, with better strategies for HIV care (including anti-HIV treatments), women are living longer, healthier lives.
An important presentation at the conference discussed the unique issues of older women (defined as over 45) living with HIV. Some of these issues are physical conditions common among older people in general. These include high blood pressure, arthritis, diabetes, osteoporosis, heart and liver disease, and cancer.
Women over 45 should remind their doctors about age-appropriate health screening. Doctors can sometimes be so focused on treating and managing HIV that they forget to deliver age-appropriate health screening that includes monitoring for all the conditions noted above.
Depression is also a common issue among older women. While obvious psychological and social factors can increase rates of depression among positive older women (including fear of disclosure and loneliness), there may also be a physiologic basis for depression.
After menopause, women produce less of the chemical serotonin. Low levels of this chemical are associated with depression, though this doesn't necessarily mean that low levels cause depression. Hormone-replacement therapy may lessen incidence of depression by raising serotonin levels. However, more studies are needed to determine if this is a direct benefit of hormone-replacement therapy.