AEGiS-PRn: HIV-Infected Women May Need to Initiate Treatment Much Earlier Than Do Men

Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

HIV-Infected Women May Need to Initiate Treatment Much Earlier Than Do Men

PR Newswire; Monday June 29, 5:22 pm EST

GENEVA, June 29 /PRNewswire/ -- Today, at the 12th Annual International AIDS Conference at Geneva, researchers from the Johns Hopkins School of Public Health presented a new study which showed that if an HIV-infected woman has half the viral load level (the quantity of HIV-1 virus circulating in the bloodstream) of an infected man, she will develop AIDS as quickly as he. Similarly, an HIV-infected woman whose viral load level is comparable to a man's is likely to be much further along the path towards AIDS.

Viral load in plasma is currently used to determine when combination antiretroviral treatment should be initiated in both men and women, even though most of the data about viral load were obtained from studies of gay men. The current findings suggested that viral load's association with AIDS prognosis may have to be adjusted downward for women.

Lead author Homayoon Farzadegan, PhD, associate professor, Epidemiology, the Johns Hopkins School of Public Health, said, "Although it remains unclear why, our data suggest that the current HIV-1 viral load levels now used to signal initiation of antiretroviral therapy may have to be revised downward for women by as much as one-half."

The scientists examined blood samples from a cohort of men and women who were HIV-positive injection drug users. First, plasma specimens that had been frozen and saved several years earlier were analyzed in order to establish baseline viral load values. Then, fresh blood specimens were collected periodically and their levels of HIV-1 viral load quantified by using three different independent methods: branched-chain-DNA (b-DNA), reverse- transcriptase PCR (RT-PCR), and a quantitative microculture technique.

All three laboratory techniques showed that, at both baseline and follow- up, HIV viral load levels were significantly lower in women than in men, even after adjusting for CD4+ cell count, race, and drug use. For instance, RT-PCR revealed that the women's median baseline viral load was 3,365 copies of HIV-1 RNA per milliliter of blood, compared to 8,907 for men; at follow-up, in men and women at similar stages of the disease, women had a median of 45,416 copies versus 93,130 for men.

The study also verified that at the same degree of illness women had CD4+ cell counts comparable to those of men, and that participants' use of antiretroviral therapy did not alter the association of gender and viral load values. The current guidelines recommend initiating therapy when plasma viral load levels are greater than or equal to 10,000 copies per milliliter and when CD4+ cell counts are greater than or equal to 500 cells per microliter.

The study was supported by a grant from the National Institute on Drug Abuse.

SOURCE: Johns Hopkins School of Public Health

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