02/19/10

PRN Report from 17th CROI:  Gender and Race Issues in Acute and Early HIV Infection

Dr. Aime Meditz presented data from a cohort of subjects enrolled in the Acute Infection and Early Disease Research Program between 1997 and 2007. This was a North American multicenter, prospective, observational cohort of subjects diagnosed with acute or recent HIV infection. Significant differences in race and gender were found.

There were 124 (5.4%) women out of the 2277 HIV seroconverters.

At baseline, women had lower HIV viral loads (VL) (P<0.001) and 66 more CD4 cells/mm3 (P=0.006) than men after controlling for age and race. Also, women had similar but fewer symptoms of primary infection (P<0.001). After adjusting for time of follow-up, women had 2.17 times more combined HIV-related and AIDS-defining events per person then men (P<0.007). Non-white women had more HIV-related and AIDS-defining events as well, (P<0.001 and P=0.007 respectively).

An Extended Cox Model was used to evaluate time to ART initiation, and was adjusted for age, injection drug use, time-varying VL’s, CD4 count and whether ART initiation guidelines for CD4 thresholds were met. White women started therapy earlier than white men (P=0.04), non-white women (P=0.004) and non-white men (P= 0.04). Sex and race did not affect response to ART at 6 months.

Race was also a factor in morbidity. After controlling for IDU, baseline CD4 and VL, increased morbidity persisted for non-white women (P<0.001). An interesting finding showed that living in the southern United States was associated with increased HIV-positive or AIDS-related events, and that this association is even more pronounced in non-whites.

As this was an observational study, it had limitations. However the results warrant further investigation into possible causes such as access to care, cultural barriers and HIV testing.

Reference:
Meditz et al. Sex and Race Influence Clinical Presentations and Outcomes following Primary HIV-1 Infection. Presented at the 17th Conference on Retroviruses and Opportunistic Infections, San Francisco. Oral Abstract #137.

Source: Reporting from San Francisco for PRN News: Susan Weiss, FNP