United Press International - Tuesday, 11 July 2000
Ed Susman, UPI Science News

"There is indeed a sex difference in viral load (the level of human immunodeficiency virus circulating the blood of a patient)," said Dr. Timothy Sterling, an assistant professor of infectious diseases at the Johns Hopkins Medical Institutions. "You would assume that if women start out with a lower viral load than men, they would have a lower risk of progressing to AIDS, but they have the same risk."

Sterling suggested that because current guidelines suggest not treating HIV-infected people until their viral load reaches 20,000 copies of HIV per milliliter of blood, women who are at risk of developing AIDS would not receive treatment that could fend off the infections that destroy a person's quality of life and eventually can be fatal.

In a presentation at the 13th International AIDS Conference, Sterling and colleagues said he enrolled more than 3,300 HIV-negative intravenous drug abusers in his study. Eventually 202 of the subjects (156 men and 46 women) seroconverted -- researchers found evidence of AIDS virus in their blood, and the patients' viral load was measured.

The average viral load for the men in the study was 50,766 copies per milliliter of blood; for women the average viral load was 15,103, Sterling said. In that group, 29 men developed AIDS, and their average viral load was 77,822; 15 women advanced to AIDS and their viral load was 17,149.

Over the past several years, various studies have yielded conflicting results as to whether viral loads differ between HIV positive men and women.

"The jury is still out on exactly what these studies mean,' said Dr. Scott Holmberg, a senior epidemiologist at the Centers for Disease Control and Prevention (CDC). "We are not sure that these results are reproducible and we are not sure what its clinical relevance is."

Dr. John Nkengasong, chief of Laboratoire de Virologie, Abidjan, Cote d'Ivoire, said he had also investigated differences between men and women and their viral loads. However, after analyzing 1,800 patients he was unable to find an outcome difference between the sexes.

However, Nkengasong suggested that further study of the differences in viral load and the possible affect on prescription habits need to receive further study.

Sterling said, "The current viral load cutoffs for the initiation of antiretroviral therapy were developed based on data from men. This study demonstrates that current cutoffs would result in sex biased differences in treatment eligibility, and that therefore current guidelines should be reassessed, particularly early in the course of infection. A viral load of 17,000 does not mean the same thing in a woman as it does in a man."

He said that the data shows there is a sex difference and the information "should be incorporated into treatment guidelines for women."
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