Sunday, February 13, 2011

Race, Sex, and Clinical Outcomes in Early HIV Infection

Race, Sex, and Clinical Outcomes in Early HIV Infection

In the U.S., nonwhite women from the South had the worst outcomes of any group analyzed.
Previous studies have shown that, in established HIV infection, women have lower viral loads and higher CD4-cell counts than men, and nonwhites have lower viral loads than whites. Do these differences by race and sex influence clinical presentations and outcomes during early HIV infection?

To find out, researchers evaluated longitudinal data from 2277 individuals who were diagnosed with acute or recent HIV infection between 1997 and 2007. Women made up only 5% of the cohort, and 55% of them were nonwhite. In contrast, only 23% of the men were nonwhite. Most participants were from the western or midwestern U.S., but 45% of the nonwhite women were from southern states. No information was available on hepatitis coinfection, insurance coverage, income, education, or mental health. Mean follow-up time was approximately 4 years.
As expected, women had lower baseline viral loads and higher baseline CD4-cell counts than men. However, these differences disappeared within 2 years among individuals who had not yet initiated antiretroviral therapy (ART). The proportion of patients who started ART during the study period was similar between men and women (69% and 64%), as was the proportion who achieved virologic suppression within 6 months of ART initiation (81% and 77%). However, rates of ART initiation differed significantly by race and geographic location: Nonwhite men and women were less likely to start ART than white men, who were, in turn, less likely to start ART than white women. Patients from the South were less likely to start ART than those from other regions.

Women were more likely than men to report HIV-associated non–AIDS-related conditions (persistent generalized lymphadenopathy, diarrhea, peripheral neuropathy) and certain AIDS-defining illnesses (recurrent bacterial pneumonia). Of all the groups analyzed, nonwhite women in the South had the highest rate of HIV/AIDS-related events (81%).
Comment: The data presented in this paper open the door for further investigation into the influence of biology on the course of HIV infection. However, removing sociodemographic barriers to optimal care will likely have a much greater impact on outcomes than understanding biological determinants of progression and response to treatment.
Sonia Nagy Chimienti, MD

Published in Journal Watch HIV/AIDS Clinical Care February 7, 2011

Meditz AL et al. Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection. J Infect Dis 2011 Feb 15; 203:442.

Original article (Subscription may be required)
Medline abstract (Free)

Armstrong WS and del Rio C. Gender, race, and geography: Do they matter in primary human immunodeficiency virus infection? J Infect Dis 2011 Feb 15; 203:437.
Original article (Subscription may be required)
Medline abstract (Free)

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