Gender and clinical outcomes after starting highly active antiretroviral treatment: a cohort study.
OBJECTIVE
To examine gender differences in clinical response to highly active antiretroviral treatment (HAART).


METHODS
A cohort of HIV-positive individuals was examined. Outcomes assessed were hospital admission and disease progression (either a new AIDS diagnosis or death) after starting HAART. Hazard ratios (HRs) derived using Cox regression methods compared female-to-male rates, adjusting for other factors independently associated with outcome.


RESULTS
Four hundred ninety-seven men and 146 women were followed up over a median of 13 months after starting HAART. Eighty-one percent of men were white, and 75% were homosexual. Fifty-eight percent of women were black African, and 86% were in the heterosexual risk category. The baseline CD4 count was higher in men than in women (191 vs. 145 x 10; p < .01), but viral loads were similar (5.2 vs. 5.1 log copies/ml, respectively; p = .13). Fifty-six percent of men and women were treatment naïve. Eighteen percent of men and women were admitted during follow-up, with 17% of male admissions and 12% of female admissions being the result of an AIDS-defining illness. The HR for admission was 0.76 (95% confidence interval [CI]: 0.46-1.27; p = .30) for women relative to men. Eleven percent of the men and 8% of the women experienced progression. Eighty-eight percent of progressions were the result of a new AIDS diagnosis (46 in men, 11 in women), and 8 men died. The HR for progression was 0.70 (CI: 0.36-1.33; p = .28).


CONCLUSIONS
Our results suggest a possible benefit in women compared with men in the rate of outcomes after HAART. Further analysis with longer follow-up or greater numbers would enable a more powerful analysis to be performed.
Moore
Antonia L
AL
Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Hampstead, London, UK. antonia.moore@pcps.ucl.ac.uk
Sabin
Caroline A
CA
Johnson
Margaret A
MA
Phillips
Andrew N
AN
D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D010343:Patient Admission; D012737:Sex Factors; D016896:Treatment Outcome