Age, adherence and injection drug use predict virological suppression among men and women enrolled in a population-based antiretroviral drug treatment programme.
OBJECTIVE
To characterize 1-year virological response to antiretroviral therapy and its determinants by sex.


METHODS
This is a population-based analysis of antiretroviral therapy naive HIV-positive adult men and women. Factors associated with sex and with plasma HIV RNA viral load suppression to below 500 copies/ml were examined using non-parametric tests and logistic regression analyses.


RESULTS
A total of 739 subjects (92 women and 647 men) were eligible. Female participants were younger (34 vs 37 years; P < 0.001), less likely to have AIDS (6.5 vs 14.4%; P = 0.039), more frequently injection drug users (44.6 vs 25.2%; P = 0.001) and were less likely to be adherent to therapy (34.8 vs 62.9%; P < 0.001) than male participants. There was no difference in baseline median CD4 count (P = 0.424) or HIV RNA levels (P = 0.140), physician experience (P = 0.057), or with respect to antiretroviral regimens containing protease inhibitors or non-nucleoside reverse transcriptase inhibitors (P = 0.911). With treatment, 46.7% (43/92) of women and 64.8% (419/647) of men (P = 0.001) suppressed HIV RNA viral load to below 500 copies/ml at 1 year. In a multivariate analysis, the association of sex with HIV RNA response to antiretroviral therapy fell from statistical significance (odds ratio 1.18; 95% CI: 0.72-1.95) after adjusting for adherence, injection drug use and age.


CONCLUSIONS
Our data indicate that in this population-based setting, sex differences in 1-year virological response to antiretroviral therapy are explained by age, adherence and injection drug use.
O'Connell
Jacqueline M
JM
BC Centre for Excellence in HIV/AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Braitstein
Paula
P
Hogg
Robert S
RS
Yip
Benito
B
Craib
Kevin J P
KJ
O'Shaughnessy
Michael V
MV
Montaner
Julio S G
JS
Burdge
David R
DR
D000328:Adult; D000367:Age Factors; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016015:Logistic Models; D008297:Male; D010349:Patient Compliance; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*
D012367:RNA, Viral