AEGiS-15IAC: Gender disparity in HIV treatment and AIDS opportunistic illnesses (OI).

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Gender disparity in HIV treatment and AIDS opportunistic illnesses (OI).

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. MoOrC1032)

McNaghten AD, Hanson DL, Aponte Z, Sullivan PS, Wolfe MI
CDC, Atlanta, United States

Introduction: Despite improvements in treatment and prevention of HIV-related illnesses in the US, AIDS morbidity remains a substantial health problem and disparities in medical care of HIV-infected persons exist. To examine gender differences in HAART use, OI incidence and OI trends, we studied OI incidence and prescribed HAART in HIV-infected adults.

METHODS: We used medical record data of 5,611 women and 14,061 men receiving care in 10 US cities from 1999 to 2001 from the CDC's Adult/Adolescent Spectrum of HIV Disease project. Poisson regression was used to compare OI incidence per 1000 person-years (PY) by gender and to assess trends stratified by gender, controlling for nadir CD4 and other potentially confounding risk factors. We estimated the proportion receiving HAART for men and women with a history of CD4<350 cells/muL or AIDS OI; hypothesis testing was performed using multivariable logistic regression with generalized estimating equations.

RESULTS: Men had higher incidence of KS (5.6 vs 0.6 cases/1000 PY), cryptosporidiosis (CRYPS) (2.2 vs 0.7), and cryptococcosis (CTCC) (4.2 vs 2.6); females had higher incidence of esophageal candidiasis (27.6 vs 19.4) and cytomegalovirus disease (4.2 vs 3.3). For men, incidence was significantly declining in CRYPS, CTCC, KS, recurrent pneumonia, Mycobacterium avium complex, TB, and wasting; only invasive cervical cancer and TB were declining for women. HAART was prescribed for 74% of men and 70% of women overall (adjusted OR=0.88, p<.01), and for 67% of male and 61% of female IDU (adjusted OR=0.79, p<.01).

CONCLUSIONS: Our findings demonstrate gender differences in OI rates and trends, as well as in prescribed HAART. These findings may reflect differences in access to care and prevention services, sexual behavior, socioeconomic status, and biology. Treatment, morbidity and mortality should continue to be monitored to better understand social barriers and health care factors that contribute to disparities by gender.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Antiretroviral Therapy, Highly Active, HIV Infections, Incidence, Risk Factors, Mycobacterium avium-intracellulare Infection, Mycobacterium avium Complex, Cryptosporidiosis, Drug Therapy, Combination, Candidiasis, Humans, Male, Female, Animal, Adolescence, Adult, therapy, drug therapy

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MoOrC1032