For many years, particularly in the 1980s when people first heard about AIDS, it was seen as a gay male disease. As a result, some HIV positive women may not have been aware of their infection until serious symptoms appeared and their disease had progressed. Moreover, this stereotype of who-gets-AIDS may have influenced decision-making by some doctors who treat women, who may have been reluctant to test their female patients for HIV. This, along with many other factors — including the lack of social networks for HIV positive women in the early years of the epidemic, women's role as caregivers, their lower socioeconomic status and partner violence — may have contributed to reduced survival for HIV positive women compared to their male counterparts.

Researchers in Italy and the U.K. have been monitoring the health of a large number of HIV positive men and women for several years. They analysed information in their database to compare differences between men and women in the following areas:

• their ability to access anti-HIV therapy
• the quality of that therapy
• rates of stopping therapy
• the development of AIDS-related illnesses

Study details

Between 1996 and February 2001, researchers recruited 3,658 HIV positive subjects (37% women, 63% men) who had the following profile at the start of the study:

Men:

• average age – 36 years
• proportion with AIDS – 12%
• proportion with hepatitis C virus – 70%
• average CD4+ count – 402 cells
• average viral load – 25,000 copies

Women:

• average age – 34 years
• proportion with AIDS – 9%
• proportion with hepatitis C virus – 45%
• average CD4+ count – 451 cells
• average viral load – 16,000 copies

Results

Researchers found that the following proportion of subjects began therapy once they entered the study:

• men – 64%
• women – 61%

The researchers grouped together men and women who entered the study at roughly the same time. In general, they found that despite entering the study at the same time, men began therapy about three months earlier than women did.

However, when researchers analysed the data, they noticed that even though, on average, men began therapy earlier than women, both sexes began therapy at the appropriate time for their health care needs — when taking into account CD4 counts and viral loads. This suggests that doctors were applying treatment guidelines equally to both sexes, at least when it came to the timing of therapy.

Type of therapy

The researchers also looked at the complexity of combination therapy which people with HIV/AIDS used initially. They found the following:

• men – 71% began treatment with a combination of three drugs
• women – 66% began therapy with a combination of three drugs

Why some women were offered less complex regimens was not clear.

Interrupting therapy

The researchers looked at the data about stopping therapy. Specifically, they were interested in PHAs who stopped taking their medications for three or more months. In this analysis, they found the following:

• More women (19%) than men (15%) interrupted their therapy.
• Women were twice as likely as men to stop taking "at least one drug" in their combination.

AIDS-related illnesses

A total of 147 subjects developed infections and/or cancers while in the study. There were a total of 43 deaths, nine of which were not related to HIV (for example, accidents). There were no major differences between men and women in the development of AIDS-related complications or deaths.

Future research

This study is interesting but the findings raise some questions such as:

• Why were more women than men using less-than-optimal anti-HIV therapy?
• Did more women interrupt their therapy because of side effects?
• If so, are women more likely to experience side effects than men?

We hope that the research team seizes the opportunity to answer these and other important questions relating to the care and treatment of both men and women with HIV.

REFERENCE

Murri R, Cozzi-Lepri A, Phillips AP, et al. Access top antiretroviral treatment, incidence of sustained therapy interruptions and risk of clinical events according to gender: evidence from the ICONA study.Sixth International Congress on Drug Therapy in HIV Infection, 17-21 November 2002, Glasgow. Plenary lecture 6.4

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