Impact of gender on response to highly active antiretroviral therapy in HIV-1 infected patients: a nationwide population-based cohort study

Abstract

BackgroundImpact of gender on time to initiation, response to and risk of modification of highly active antiretroviral therapy (HAART) in HIV-1 infected individuals is still controversial.MethodsFrom a nationwide cohort of Danish HIV infected individuals we identified all heterosexually infected women (N=587) and heterosexually infected men (N=583) with no record of Hepatitis C infection diagnosed with HIV after 1 January 1997. Among these subjects, 473 women (81%) and 435 men (75%) initiated HAART from 1 January 1997 to 31 December 2009. We used Cox regression to calculate hazard ratio (HR) for time to initiation of HAART, Poisson regression to assess incidence rate ratios (IRR) of risk of treatment modification the first year, logistic regression to estimate differences in the proportion with an undetectable viral load, and linear regression to detect differences in CD4 count at year 1, 3 and 6 after start of HAART.ResultsAt initiation of HAART, women were younger, predominantly of Black ethnicity and had a higher CD4 count (adjusted p=0.026) and lower viral load (adjusted p=0.0003). When repeating the analysis excluding pregnant women no difference was seen in CD4 counts (adjusted p=0.21). We observed no delay in time to initiation of HAART in women compared to men (HR 0.91, 95% CI 0.79-1.06). There were no gender differences in risk of treatment modification of the original HAART regimen during the first year of therapy for either toxicity (IRR 0.97 95% CI 0.66-1.44) or other/unknown reasons (IRR 1.18 95% CI 0.76-1.82). Finally, CD4 counts and the risk of having a detectable viral load at 1, 3 and 6 years did not differ between genders.ConclusionsIn a setting with free access to healthcare and HAART, gender does neither affect time from eligibility to HAART, modification of therapy nor virological and immunological response to HAART. Differences observed between genders are mainly attributable to initiation of HAART in pregnant women.

Enhanced immunovirological response in women compared to men after antiretroviral therapy initiation during acute and early HIV‐1 infection: results from a longitudinal study in the French ANRS Primo cohort

“…The immunological advantage women had over men during AHI strengthened over the first year of ART and was then maintained with sustained ART. Some studies have reported that women have greater CD4 + gain than men one to three years after initiating ART [31,37‐41], whereas in others, CD4 + T‐cell counts rose similarly between men and women [29,42‐45]. Here we observed that women retained a higher CD4 + T‐cell count than men throughout follow‐up under ART.…”

Gender inequalities in the response to combination antiretroviral therapy over time: the Swiss HIV Cohort Study

“…Similarly to other cohorts , women starting cART were younger, were more frequently of non‐white ethnicity, were less educated, and had higher CD4 cell counts and lower HIV RNA than men. In line with the findings of other studies , after adjustment for potential confounders, no major differences in virological suppression at 1, 2 and 5 years were observed between the sexes in a setting of equal access to cART. In multivariate analysis, among sociodemographic factors, only non‐white ethnicity was an independent risk factor for not achieving virological suppression, suggesting that immigration (mainly from sub‐Saharan Africa to Switzerland) may explain differences in virological suppression between the sexes.…”

“…This observation is supported by higher CD4 cell counts in women than men among HIV‐negative patients, and higher immune activation in the presence of HIV infection . By contrast, several reports indicated similar increases in CD4 cell counts between the sexes . However, discrepancies among these studies may be explained by differences in the study populations, with some studies including patients with different lifestyles such as MSM , and lower proportions of women precluding the detection of such small differences.…”

Differences in Response to Antiretroviral Therapy by Sex and Hepatitis C Infection Status

“…[14][15][16] Sex may also modify the response to ART among HIV-infected individuals. While some studies have found no association of sex with response to ART, [17][18][19] others have suggested that women have superior virologic, immunologic, and clinical outcomes compared with men. [20][21][22][23][24] It is unknown if this is attributable to biological factors, such as pharmacokinetics, 25,26 or behavioral or structural factors, such as adherence 27 or access to or quality of care.…”