Important note: Information in this article was accurate in April 2000. The state of the art may have changed since the publication date.The 1999 National Conference on Women and HIV/AIDS, held last October in Los Angeles, convened its largest number of participants. Over 2,000 researchers, clinicians, policymakers, AIDS activists and HIV-positive women came to discuss new treatment, behavioral and political issues affecting women. The strong and diverse turnout provided a lively and sometimes conflicting forum that reflected the growing visibility of women's issues. Following are selected highlights from the conference. For more on the 1999 Conference, read WISE Words #5, which fully covers the conference.
Studies that have shown worse outcomes for women have attributed poorer survival and disease progression to differences in access to healthcare. The Community Program for Clinical Research on AIDS (CPCRA), a community based research network, studied this issue. It reviewed the outcomes of men and women receiving similar medical care. The CPCRA divided them into three groups according to the anti-HIV therapy used: one-, two- or three-drug therapy. Across all groups, no gender differences were noted in rates of disease progression or death. Factors that seemed to influence survival and rates of disease progression included CD4+ cell count and type of treatment, with those on three-drug therapy doing better than those on one or two drugs.
Disease progression and survival rates do not appear to vary between genders in populations who have similar access to healthcare and therapy. However, studies with larger numbers of women are needed to determine whether gender influences disease progression or response to therapy when using potent combination therapy. Also, two important studies point to the fact that women of color and women with past or present drug use—who make up most of the women in the epidemic—still lack access to regular healthcare and are less likely to use combination therapy.
There were several presentations on women and side effects related to anti-HIV therapy. Recent studies reported on women's experiences of side effects compared to those of men. They found that women are less likely to tolerate a full dose of ritonavir (Norvir) than men. Women also seem more prone to rashes from using nevirapine (Viramune) and nelfinavir (Viracept). In addition, women might be more likely to develop lactic acidosis, a rare but life-threatening condition reported in some people taking anti-HIV therapy.
Studies are currently exploring the possible causes of gender-specific side effects. Biological factors like body composition and weight, metabolic and hormonal differences, and presence of other complicating factors (concurrent auto-immune diseases, anemia, etc.) were discussed. Further analysis of these factors is sorely needed to determine if or how they contribute to these gender differences. This is particularly true given the many personal examples shared by women at the conference struggling with drug side effects.
Anemia is a low amount of red blood cells, the cells that carry oxygen throughout the body. Early signs include feeling fatigued and low cell counts on lab reports. Anemia has long been shown to negatively affect quality of life and survival among men living with HIV. A study examining the rate of anemia in women who participated in the WIHS support these findings among women.
The study found that HIV-positive women were more likely to be anemic than their HIV-negative counterparts, regardless of age, ethnicity and past or present drug use. Among women living with HIV, risk of anemia was related to: history of an AIDS-defining condition, low CD4+ cell count (below 200), high viral load (above 50,000 copies/mL) and the use of AZT (zidovudine, Retrovir). African American race and red blood cell counts below 80 are also associated with anemia.
Epoetin (Epogen, Procrit) is used to treat mild-to-moderate anemia. One study examined epoetin given once a week by injection for eight weeks in HIV-positive women with anemia. Major increases in red blood cells were seen in most of the women, as well as improved quality of life. Overall, the drug was well tolerated with only minor side effects, like nausea, body aches and fever. However, people with severe anemia should not count on epoetin to solve their problem; in these cases blood transfusions may be still be required.
This is an area of obvious interest and concern, particularly among older HIV-positive women using or considering hormone replacement therapy (HRT). Unfortunately, it was barely dealt with at the conference. One study compared HIV levels in women using hormonal contraceptives (oral contraceptives, injectable DepoProvera, Norplant). It found that the contraceptives did not affect viral load, but more research is needed to examine the interaction of contraceptives with specific anti-HIV therapies and HIV disease itself.
Another study looked at testosterone replacement therapy in women with AIDS-related weight loss and a related condition, amenorrhea (loss or absence of periods). It found that women who took a replacement dose of testosterone (a dose bringing the hormone to normal levels in the blood) experienced weight gain, return of menstruation and improved quality of life.
Finally, depression is a common condition among older and HIV-positive women. While depression among older women may be influenced by psychological and social factors, it may be physical. In short, after menopause women produce less serotonin. Low levels of serotonin have been linked to depression. The use of HRT to ease depression in HIV-negative women is being explored and should also be looked at for women living with HIV. However, like testosterone replacement therapy, studies examining HRT must also consider the possible interactions with anti-HIV drugs and HIV disease itself.
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