AIDS Treatment News #162, November 6, 1992
Nancy Solomon
A natural history study of women with HIV was promised by the National Institutes of Health during the December 1990 Women and HIV Conference in Washington D. C. But the Request for Applications (RFA), the governmental process that allows researchers to apply for funding and participation in the study, has not yet been released.
"We could have good answers by now," said Dr. Judith Cohen, an epidemiologist who studies HIV in women at the University of California, San Francisco. "While we waited the last year, 10,000 more women were diagnosed."
A similar study of men, the Multicenter AIDS Cohort Study (MACS), has been following the progress of more than 5,000 gay and bisexual men since 1984, and has spent $100.3 million.
The National Institute of Allergies and Infectious Disease (NIAID) is coordinating the women's study, called the Women's Interagency HIV Study, and has allocated $5 million for 1993. A nurse in the epidemiology branch said that the RFA was just approved by the head office at the NIH and that it should be published by mid-November at the earliest.
"It just takes a long time for RFA to go through the approval process," said Miriam Galbraith, a nurse consultant for NIAID who is the deputy project officer for the study. "The idea has to be approved before writing the RFA itself."
In San Francisco, Dr. Cohen is waiting for the RFA so that she can apply for funds for the study. She is working with Bay Area Research Consortium on Women and AIDS (BARCWA), which is ready with 450 HIV-positive women to begin the natural history study.
Once approved, the study would continue to enroll women as soon as they know they are HIV-positive and monitor their health for four years. "We just don't have much research on women," Dr. Cohen said. "It is particularly important (to look at) women (because) we have a whole set of indirect evidence that something else is going on ...women have body parts that men do not."
The current standard of care for women with HIV does not include information about gynecological problems, Dr. Cohen said.
The Centers for Disease Control announced on October 27 that it would expand the definition of AIDS illnesses to include invasive cervical cancer, pulmonary tuberculosis and recurrent pneumonia, after a two year battle by women activists. This decision, while it does not go far enough, is expected to improve the standard of care for women, activists said. Earlier this year, the CDC announced plans to expand the AIDS definition to include people whose T-cell count is below 200, but criticism that the change still did not address women's needs stalled implementation.
Women continue to have shorter survival rates than men, although the gap has narrowed. Dr. Cohen published research in the July 1992 Journal of Infectious Diseases that showed that men in San Francisco survive four to five months longer than women in San Francisco. The study examined men and women with comparable opportunistic infections.
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