Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection.
BACKGROUND
It is unknown whether sex and race influence clinical outcomes following primary human immunodeficiency virus type 1 (HIV-1) infection.


METHODS
Data were evaluated from an observational, multicenter, primarily North American cohort of HIV-1 seroconverters.


RESULTS
Of 2277 seroconverters, 5.4% were women. At enrollment, women averaged .40 log₁₀ fewer copies/mL of HIV-1 RNA (P < .001) and 66 more CD4(+) T cells/μL (P = .006) than men, controlling for age and race. Antiretroviral therapy (ART) was less likely to be initiated at any time point by nonwhite women and men compared to white men (P < .005), and by individuals from the southern United States compared to others (P = .047). Sex and race did not affect responses to ART after 6 months (P > .73). Women were 2.17-fold more likely than men to experience >1 HIV/AIDS-related event (P < .001). Nonwhite women were most likely to experience an HIV/AIDS-related event compared to all others (P = .035), after adjusting for intravenous drug use and ART. Eight years after diagnosis, >1 HIV/AIDS-related event had occurred in 78% of nonwhites and 37% of whites from the southern United States, and 24% of whites and 17% of nonwhites from other regions (P < .001).


CONCLUSIONS
Despite more favorable clinical parameters initially, female HIV-1-seroconverters had worse outcomes than did male seroconverters. Elevated morbidity was associated with being nonwhite and residing in the southern United States.
Department of Medicine, University of Colorado Denver, Aurora, CO 80045, USA. amie.meditz@ucdenver.edu
Amie L
AL
Meditz
Samantha
S
MaWhinney
Amanda
A
Allshouse
William
W
Feser
Martin
M
Markowitz
Susan
S
Little
Richard
R
Hecht
Eric S
ES
Daar
Ann C
AC
Collier
Joseph
J
Margolick
J Michael
JM
Kilby
Jean-Pierre
JP
Routy
Brian
B
Conway
John
J
Kaldor
Jay
J
Levy
Robert
R
Schooley
David A
DA
Cooper
Marcus
M
Altfeld
Douglas
D
Richman
Elizabeth
E
Connick
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018562:Disease Transmission, Infectious; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D009656:North America / Q000453:epidemiology; D012367:RNA, Viral / Q000097:blood; D044469:Racial Groups; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D012367:RNA, Viral
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