Clinical and immunologic progression in HIV-infected US women before and after the introduction of highly active antiretroviral therapy.
OBJECTIVE
To examine factors associated with clinical and immunologic HIV disease progression in a cohort of US women.


METHODS
Analysis of data from a prospective, longitudinal, case-control study of HIV-infected women followed every 6 months for 7 years.


METHODS
Four urban clinical centers in the United States.


METHODS
648 HIV-infected women who did not have AIDS at time of entry into the study.


METHODS
Structured clinical and behavioral interviews; protocol-directed physical examinations; CD4 lymphocyte counts; plasma HIV RNA; infectious pathogen serologies. RESULTS With 2304 women-years of follow-up, 46.1% of the women developed AIDS; however, 93.3% of the diagnoses were based on CD4 counts dropping to <200 cells/mm(3). Only 10.6% of the women with CD4 counts <200 cells/mm(3) developed an opportunistic infection. Baseline CD4 count was the strongest predictor of subsequent clinical progression. Illicit substance use, multiple pregnancies, demographic variables, and other infections were not associated with progression. Among women with CD4 counts >500 cells/mm(3) at baseline, those who were anemic or had hepatitis C were more likely to progress to AIDS. By the end of the study, only 52% of the participants were on highly active antiretroviral therapy (HAART).


CONCLUSIONS
Despite underutilization of HAART in this multicenter cohort of urban women, opportunistic infections were uncommon, despite CD4 declines.
Mayer
Kenneth H
KH
Miriam Hospital and dagger Brown University, Providence, Rhode Island 02906, USA. Kenneth_Mayer@brown.edu
Hogan
Joseph W
JW
Smith
Dawn
D
Klein
Robert S
RS
Schuman
Paula
P
Margolick
Joseph B
JB
Korkontzelou
Christina
C
Farzedegan
Homayoon
H
Vlahov
David
D
Carpenter
Charles C J
CC
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000276:immunology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014505:Urban Population