CROI 2009: Large Meta-analysis Indicates Antiretroviral Therapy Works as Well for Women as for Men

Since the early years of the AIDS epidemic, researchers and advocates have debated whether HIV positive women benefit as much as men from antiretroviral therapy. Some studies in the early HAART era suggested that women did not fare as well, but many believe this was a reflection of poorer access to care, differences in socioeconomic status, or other factors.

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AIDS-related Deaths in France Are More Frequent in Women than in Men since 2000

As reported at the 15th Conference on Retroviruses and Opportunistic Infections (CROI 2008) last week in Boston, French researchers conducted a retrospective sub-study of the Mortalité 2000 and 2005 surveys to determine characteristics at the time of death in women compared to men with HIV/AIDS.

While numerous studies have looked at the changing causes of mortality in people with HIV/AIDS, few have focused on HIV positive women.

All deaths occurring in HIV-infected adults were reported through years 2000 and 2005 in national surveys. A standardized questionnaire collected social, demographic, clinical, biological, and therapeutic characteristics. 

Results

• 32% of HIV positive women who died were infected through injection drug use (vs 30% of men) and 53% were infected through heterosexual intercourse (vs 25% of men).

• In women, the age at death was lower than that of men (43 vs 46 years; P < 0.001).

• Socioeconomic "precariousness" was also more common among the HIV positive women compared with men (38% vs 28%; P = 0.006).

• Men also had a higher rate of dyslipidemia (4% vs 10%; P = 0.01).

• The 3 AIDS-related causes of death that were more frequent in 2005 were non-Hodgkin's lymphoma (19% vs 21% in 2000), progressive multifocal leukoencephalopathy (18% vs 3%), and cerebral toxoplasmosis (14% vs 17%).

• Breast cancer was a cause of death in 3% and cervical cancer in 2% of the women.

Conclusion

In conclusion, the investigators noted that, in the context of a global decrease since 2000, "AIDS-related deaths are nowadays more frequent in women than in men."

"Even in a setting of universal access to care, HIV positive women, especially migrants in poor socioeconomic conditions, may not benefit from optimal case management," they added.

Finally, they concluded, "Conversely, the lower proportion of non-AIDS causes of deaths observed in women may be explained by a lower prevalence of traditional risk factors of respiratory or cardiovascular diseases and of violent deaths."

INSERM U593, Bordeaux, France; Ctr Hosp Univ Bordeaux, France; Univ Bordeaux, France; HospPitie-Salpetriere, Paris, France; Univ Pierre and Marie Curie, Paris, France; Ctr Hosp Univ Cochin-Tarnier, Paris, France; Ctr Hosp Nancy, France; Ctr Hosp Univ Nice, France; INSERM U720, Paris, France. 


2/15/08

Reference

M Hessamfar-Bonarek, G Chene, D Salmon, and others. (for the Mortalité 2000 & 2005 Study Group). Causes of Death in HIV-infected Women and Their Evolution Since 2000: The Mortalité 2000 and 2005 Surveys, ANRSEN19. 15th Conference on Retroviruses and Opportunistic Infections. Boston, MA. February 3-6, 2008. Abstract 666.