Survival and Disease Progression According to Gender of Patients With HIV Infection: The Terry Beirn Community Programs for Clinical Research on AIDS

Objective.—To compare disease progression and mortality between women and men infected with human immunodeficiency virus (HIV).Design.—Multicenter cohort.Setting.—Seventeen community-based centers participating in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA).Patients.—A t...

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Published in:	JAMA : the journal of the American Medical Association Vol. 272; no. 24; pp. 1915 - 1921
Main Authors:	Melnick, Sandra L, Sherer, Renslow, Louis, Thomas A, Hillman, David, Rodriguez, Evelyn M, Lackman, Cheryl, Capps, Linnea, Brown, Lawrence S, Carlyn, Marcia, Korvick, Joyce A, Deyton, Lawrence, Johns, Stanley, Ellison, Jacquelyn, Hickson, Micheal J, Lee, Janet, Thompson, Melanie, Creagh, Terri, Morris, Amy, Ernst, Jerome, Pollard, Cathy, Anastos, Kathryn, Bar, Mordechai, Doramajian, Elizabeth, Blatt, David, Moore, David, Renzetti, Renee, Verheggen, Rita, Luskin-Hawk, Roberta, Torres, Ramon A, Townley, David, Clanon, Kathleen, Morris, Bea, Owen, William, Brosgart, Carol, Crane, Lawrence R, Ebright, Jack, Schuman, Paula, Valuer, William, Fairclough, Colleen, Holloway, William J, Winslow, Dean, Szabo, Susan, Bincsik, Arlene, Swanson, Karen, Cohn, David L, Reves, Randall R, Grodesky, Michael J, Mesard, Carol A, Gans, Joan E, El-Sadr, Wafaa, Guity, Cheryl, Hardy, Michelle, Fuentes, Luis, Saravolatz, Louis, Markowitz, Norman, Kumi, Jones, Mastro-Polak, Diane, Hutchinson, Jill, Walker, Janice, Pablovich, Sue, Simmons, Phyllis, Kimmel, Nancy, Kocher, Jeffrey, Weisholtz, Steven, Sheridan, Annemarie, Taylor, Victoria M, Braithwaite, Jilleen, Sampson, James H, Godbey, Joel, Loveless, Mark, Salveson, Catherine, Martinez, Norma, Kerkering, Thomas M, Webster, Carol, Fisher, Evelyn, Link, Kurt, Gernon, Lawrence, Labriola, Ami, Gibert, Cynthia, Scott, John, Finley, Elizabeth, Irvin, Karen, Neaton, James D, Brelje, Tim, DuChene, Alain, Thompson, Greg, Wentworth, Deborah N, Deyton, Lawrence R, Sanvffle, Jane, Foulkes, Mary
Format:	Journal Article
Language:	English
Published:	Chicago, IL American Medical Association 28-12-1994
Subjects:	Adult AIDS-Related Opportunistic Infections - epidemiology AIDS/HIV Analysis of Variance Biological and medical sciences CD4 Lymphocyte Count Cohort Studies Disease Progression Female HIV HIV Infections - immunology HIV Infections - mortality HIV Infections - physiopathology Human immunodeficiency virus Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Male Medical research Medical sciences Mortality Risk Factors Risk-Taking Sex Factors Sexes Survival Rate United States - epidemiology United States Infection Human Immunopathology Viral disease Sex Evolution AIDS Immune deficiency Survival
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Summary:	Objective.—To compare disease progression and mortality between women and men infected with human immunodeficiency virus (HIV).Design.—Multicenter cohort.Setting.—Seventeen community-based centers participating in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA).Patients.—A total of 768 women and 3779 men enrolled in one or more of 11 protocols between September 7, 1990, and September 30, 1993.Main Outcome Measures.—Survival and opportunistic events.Results.—The median CD4+ cell count at enrollment into the cohort was 0.240 ×109/L (240/μL) for women and 0.137 ×109/L for men (P<.001). Compared with men, women were younger (36 vs 38 years), more likely to be African American or Hispanic (78% vs 44%), and more likely to have reported a history of injection drug use (49% vs 27%). Women had been followed up for a median of 14.5 months and men for 15.5 months. The adjusted relative risk (RR) for death among women compared with men was 1.33 (95% confidence interval [CI], 1.06 to 1.67; P=.01) and for disease progression (including death) was 0.97 (95% CI, 0.82 to 1.15; P=.72). Women were at increased risk for bacterial pneumonia (RR, 1.38; 95% CI, 1.05 to 1.92) and at reduced risk for the development of Kaposi's sarcoma (RR, 0.16; 95% CI, 0.04 to 0.65) and oral hairy leukoplakia (RR, 0.54; 95% CI, 0.31 to 0.94). The increased risk of death and bacterial pneumonia for women compared with men was primarily evident among those with a history of injection drug use (RR, 1.68 for death, 95% CI, 1.20 to 2.35, P=.003; RR, 1.53 for bacterial pneumonia, 95% CI, 1.03 to 2.29, P=.04). Among patients without a history of disease progression at entry, death was the first event reported for more women than men (27.5% vs 12.2%).Conclusions.—Compared with men, HIV-infected women in the CPCRA were at increased risk of death but not disease progression. Risks of most incident opportunistic diseases were similar for women and men; however, women were at an increased risk of bacterial pneumonia. These findings may reflect differential access to health care and standard treatments or different socioeconomic status and social support for women compared with men.(JAMA. 1994;272:1915-1921)
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2
ISSN:	0098-7484 1538-3598
DOI:	10.1001/jama.1994.03520240043039