AEGiS-14IAC: Gender, disease progression and response to HAART.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Gender, disease progression and response to HAART.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. ThOrC1448)

Hubert JB, Rouzioux C, Boufassa F, Delfraissy JF, Meyer L; Inserm Unite 292, Service d'Epidemiologie, CHU de Kremlin-Bicetre, Le Kremlin-Bicetre, France

BACKGROUND: It has been recently suggested to revise downwards recommendations for viral load (VL) thresholds to initiate HAART in women. We investigated whether men and women have a similar risk of progression at an equal level of VL 1) during the natural course of the infection, 2) after initiation of HAART.

METHODS: Patients: 1) 424 seroconverters (SC) enrolled in the SEROCO cohort; median follow-up before 1996, 75 months. 2) 531 individuals who started HAART during their follow-up in the SEROCO cohort; median follow-up after HAART initiation, 37 months. The effect of gender was assessed on 1) time since infection to clinical AIDS, CD4 cell count <200/ é l, and death using Cox models, 2) evolution of CD4 and VL at 12 months after HAART initiation; time since initiation of HAART to an AIDS event.

RESULTS: 1) As compared to male SC, female SC (n=94; 22%) were younger (28 vs 31 yrs), had higher CD4 cell count (mean, 688 vs 569 cells/ é l) and lower VL (3.7 vs 4.1 log copies/ml) at enrolment. Progression to AIDS was lower in women (RR=0.4, p<0.01). This benefit persisted after adjustment for age, baseline CD4 and VL (RR=0.5, p<0.04). Since differences in CD4 and VL across sexes tended to diminish after 6 yrs of infection, we fitted models with updated CD4 and VL: RR=0.6 (p<0.11), 0.8 (p=0.4) and 0.7 (p=0.3) for progression to AIDS, CD4<200/ é l and death, respectively. 2) At start of HAART, women (n=167, 31%) and men had similar CD4 (246 vs 247) and VL (4.1 vs 4.2). They experienced similar increase in CD4 (102 vs 86) and decrease in VL (0.9 vs 1.2) at 12 months. At least one AIDS event occurred in 50 patients (3.6 per 100 PY), unrelated to sex (RR=1.1, p=0.8). Adjustment for age, CD4 and VL at HAART initiation, and prior use of ART did not modify this result.

CONCLUSION: Our data do not support evidence that women experience more rapid progression of HIV infection than men at an equal level of VL, during the natural course of the disease and after HAART initiation.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Disease Progression, CD4 Lymphocyte Count, HIV Infections, Acquired Immunodeficiency Syndrome, Viral Load, Antigens, CD4, Sex, Proportional Hazards Models, Sex Factors, Human, Female, Male, immunology

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ThOrC1448