title: Sex issues in HIV-1-infected persons during highly active antiretroviral therapy: a systematic review.
abstract: BACKGROUND
  Since the introduction of highly active antiretroviral therapy (HAART), morbidity and mortality rates have sharply decreased among HIV-infected patients. Studies of possible differences between men and women in the course of HIV infection give conflicting results. The objective of this study was to assess sex differences during HAART.
  
  
  METHODS
  A literature search by using the MEDLINE database between March 2002 and February 2007 was performed to identify all published studies on the sex-specific differences on the impact of HAART. All articles with measures of effect (preferably adjusted odds ratio, relative risk or hazard ratio with 95% CI) of sex on viroimmunological and clinical parameters during HAART were included. Five different topics of interest in our research were selected: time of initiation of HAART, adherence, viroimmunological response, clinical response and adverse reactions during HAART.
  
  
  RESULTS
  US data report an initiation of HAART at an earlier disease stage in men compared with women. After initiation of HAART, most authors do not report any viroimmunological difference, although a few clinical studies showed a significantly better virological response in women compared with men. Nevertheless, women were more likely to be less adherent to antiretrovirals and to have non-structured treatment interruptions than men. This is likely to be related to the higher number of adverse reactions they experience during HAART. Finally, discordant opinions with regard to clinical benefits during HAART exist, but recent clinical and observational trials suggest a better clinical outcome for women.
  
  
  CONCLUSIONS
  We found little evidence of sex differences during antiretroviral treatment. Nevertheless, most of these studies were underpowered to detect sex differences and had limited follow-up at 6 or 12 months. Design of new gender-sensitive clinical trials with both prolonged follow-up and sample size representative of the current HIV prevalence among women are strongly needed to detect the likely sex differences of antiretroviral agents during HIV infection.
authors: National Institute for Infectious Diseases, IRCCS Lazzaro Spallanzani, Rome, Italy. nicastri@inmi.it
authors: Emanuele
authors: E
authors: Nicastri
authors: Sebastiano
authors: S
authors: Leone
authors: Claudio
authors: C
authors: Angeletti
authors: Lucia
authors: L
authors: Palmisano
authors: Loredana
authors: L
authors: Sarmati
authors: Antonio
authors: A
authors: Chiesi
authors: Andrea
authors: A
authors: Geraci
authors: Stefano
authors: S
authors: Vella
authors: Pasquale
authors: P
authors: Narciso
authors: Angela
authors: A
authors: Corpolongo
authors: Massimo
authors: M
authors: Andreoni
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012737:Sex Factors; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents