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13th International AIDS ConferenceDurban, South Africa - July 9-July 14, 2000 |
Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB403)
El-Sadr W, Bebchuk J
W. El-Sadr, Harlem Hospital Center, Division of infectious Deseases, Room 3101A, 506 Lenox Ave, New York 10037, United States, Tel.: +212 939 29 50, Fax: +212 939 29 68, E-mail: wme1@columbia.edu
OBJECTIVE: Controversy remains regarding outcome of antiretroviral therapy (ART) among women (W) compared to men (M). We assessed risk of progression of HIV disease or death (PROG) among patients (pts) enrolled in randomized CPCRA studies in past decade. These studies were grouped based on the type of combination therapy prescribed.
METHODS: Group 1 (GRP1) pts were randomly assigned dual nucleosides and Group 2 (GRP2) pts were randomly assigned triple ART. Hazard ratios (HR) and chi squares were calculated for predictors corresponding to gender, race/ethnicity, age, baseline CD4 and history (Hx) of IDU.
RESULTS: GRP1: 730 pts (62 W, 668 M) and GRP2: 885 pts (136 W, 749 M). Blacks or Latinas were 86% and 79% of W in GRP1 and 2, respectively. Injection drug use (IDU) was noted among 42% of W in GRP1 and 20% in GRP2. Percent of W increased from 9% in GRP1 to 15% in GRP2. Median follow-up was 26 and 21 months in GRP1 and GRP2, respectively. Variable GRP1 GRP2 Combined GRPs HR P HR P HR P Female/Male 1.14 0.52 0.98 0.91 1.04 0.79 Latino or Black/White 0.79 0.04 1.07 0.73 0.86 0.12 Age (years) 1.00 0.76 0.99 0.30 1.00 0.95 Baseline CD4 (cells/mm3) 0.99 >0.001 0.99 >0.001 0.99 >0.001 Hx IDU (yes/no) 1.37 0.02 1.59 0.02 1.39 0.002 Type of ART (double/triple) 2.92 >0.001
CONCLUSIONS: Previous reports that suggested that W differed from M in rates of HIV PROG, involved studies in which pts were not randomly assigned to treatments, did not have similar access to care and did not have similar follow-up. In our population, where the mix of drugs and the intensity of follow-up were the same for the two genders, as a result of randomization, baseline CD4 cell count and type of ART had a significant impact on the risk HIV PROG. History of IDU was associated with higher risk of progression. No significant difference was noted in the progression of HIV disease or mortality between women and men across these studies and the findings were consistent across the studies and over time.
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