Do gender differences in CD4 cell counts matter?
OBJECTIVE
To examine the effect of gender on disease progression and whether gender differences in CD4 lymphocyte counts persisted for the entire course from HIV seroconversion until (death from) AIDS.


METHODS
CD4 lymphocyte counts were modelled in 221 female and 443 male seroconverters following seroconversion, backwards from AIDS and backwards from death using regression analysis for repeated measurements.


RESULTS
In the period before use of highly active antiretroviral therapy (HAART), progression to AIDS and to death were marginally slower in women than in men as assessed by proportional hazards analysis. Women seroconverted for HIV, developed AIDS and died at higher CD4 cell counts than men (women: 815, 146 and 44 x 10(6) cells/l, respectively; men: 727, 49 and 22 x 10(6) cells/l, respectively), although differences were only statistically significant at AIDS onset. Declines in CD4 lymphocyte counts were not significantly affected by gender and absolute differences between men and women were stable, with exception for the trajectory close to AIDS when the decline became steeper for men than women.


CONCLUSIONS
These gender differences in CD4 lymphocyte counts suggest a delay of initiation of therapy in women compared with men (our model predicted that women reach the threshold of starting HAART at about 12 months later than men). If this delay unfavourably influences progression, treatment guidelines should be revised so that women can benefit equally from HAART.
Prins
M
M
Municipal Health Service, Division of Public Health and Environment, Amsterdam, The Netherlands.
Robertson
J R
JR
Brettle
R P
RP
Aguado
I H
IH
Broers
B
B
Boufassa
F
F
Goldberg
D J
DJ
Zangerle
R
R
Coutinho
R A
RA
van den Hoek
A
A
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006679:HIV Seropositivity / Q000276:immunology; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012727:Sex Characteristics; D013997:Time Factors
D019380:Anti-HIV Agents