Sixth International Congress

Drug Therapy in HIV Infection


17-21 November, 2002
Glasgow, UK

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Access to antiretroviral treatment, incidence of sustained therapy interruptions and risk of clinical events according to gender: evidence from the I.Co.N.A study

R Murri, A Cozzi Lepri, AP Phillips, E Girardi, G Nasti, S Ferrara, MS Mura, C Mussini, E Petrelli, M Arlotti, C De Stefano, P Vigano, L Gennero, B Salassa, G Antonucci, P Narciso, S Chigiotti, T Prestileo, R Novati, R Cargnel 1, A D'arminio Monforte 2 Int Cong Drug Therapy HIV 2002 Nov 17-21;6:Abstract No. PL6.4

Background: Possible differences between men and women in the natural history and in the clinical management of HIV infection have been described but with conflicting results. To assess the differences between genders in the likelihood of starting antiretroviral therapy (ART), in rates of sustained discontinuations from highly active antiretroviral therapy (HAART), and to establish whether a gender difference in survival exists.

Methods: Multicenter cohort study (I.Co.N.A. Study). 3,332 HIV-positive participants previously naïve to antiretrovirals were enrolled. Main outcome measures: time to starting ART, time to sustained discontinuation from HAART, and time to clinical progression.

Results: As of February 2001, 728 women and 1,350 men started ART. The median time to starting ART was 27 weeks for women and 14 weeks for men (log-rank p=0.0001). This difference was no longer significant after adjusting for either the most recent HIV RNA or CD4 count before starting ART. Men were less likely than women to start a mono/dual ART instead of HAART even after adjusting for several confounders (OR=0.75, 95% CI: 0.58-0.97, p=0.03).

Nineteen percent of women and 15% of men interrupted therapy for more than 3 months (p=0.05). At multivariate analysis, sustained therapy interruptions tended to be more frequent in women than in men (RH=1.36, 95% CI:0.97-1.89, p=0.07). Women were 2.15 more likely than men (95% CI:1.46-3.16, p=0.0001) to interrupt at least one drug because of toxicity.

Clinical progression was observed for 147 persons. Thirty-four died of HIV-related causes and 9 of non HIV-related causes. At multivariate analysis, there was no difference between women and men to develop a clinical event (RH=0.82, 95% CI:0.49-1.36, p=0.44).

Conclusions: Our data demonstrated that women were less likely to start an optimal ART and to interrupt antiretrovirals more frequently than men. No evidence for a difference in clinical progression by gender was carried out.

Presenting author: R Murri

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1 Department of Infectious Diseases, Catholic University, Rome, Italy

2 I.Co.N.A. Study Group

2002-11-17
PL6-4

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