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Gender, race, geographic location influence clinical outcomes in HIV
Meditz AL. J Infect Dis. 2011; 203:442-451.
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More health care resources should be directed towards HIV-infected women, nonwhites and people residing in the southern regions of the United States to decrease HIV-associated mortality, according to Elizabeth Connick, MD.
“Differences in the use of antiretroviral therapy accounted for some, but not the majority of differences in morbidity,” Connick, associate professor of medicine at the University of Colorado in Denver and member of the Infectious Disease News Editorial Board, said in an interview. “The specific factors that lead to worse outcomes in these populations are unclear, but likely related to socioeconomic factors.”
In the observational, multicenter study, Connick and colleagues hypothesized that differences in gender and race in CD4+ T cells and viral load are associated with differences in clinical outcomes of primary HIV-infection. The study included 2,277 HIV-1 seroconverters included in The Acute Infection and Early Disease Research Program. Patients were followed for about 4 years.
Although women had lower viral loads and higher CD4+ T cell counts at diagnosis when compared with men, the frequency of HIV-associated illness in women was more than twofold that of men (P<.001).
In addition, nonwhite women were more likely to experience an HIV-associated event (P=.035) and nonwhites who resided in the south experienced significantly more HIV-associated morbidity than those residing in other regions of the US. Antiretroviral therapy was less likely to be initiated by nonwhite women and men (P<.005) and by those residing in the southern US (P=.047).
Compared with 78% of nonwhites and 37% of whites from the southern US that experienced more than one HIV-associated outcome, 24% of whites and 17% of nonwhites from other regions experienced an HIV-associated outcome (P<.001).
“Earlier initiation of antiretroviral therapy, as well as strategies aimed at improving the general health of these individuals is urgently needed. Nevertheless, many of the barriers to good health outcomes in these populations probably reside outside of the medical care system and need to be addressed on a societal level. Unless we can overcome these barriers, substantial reductions in HIV-related morbidity and mortality in the US may not be achievable,” Connick said.
In an accompanying editorial, Wendy S. Armstrong, MD, and Carlos del Rio, MD, wrote that beyond gender, racial, and geographic differences, there are many other nonbiologic factors to be considered. “Although biologic differences in HIV presentation and outcomes exist among genders and races, these are not easily altered, nor are they known to be of major clinical significance. Socioeconomic factors play a much more important role in determining HIV disease outcomes, at an individual as well as at a population level, and although theoretically modifiable, they represent complex challenges that are beyond the traditional influence of public health.” – by Ashley DeNyse
Disclosures: Dr. Connick has no direct financial interest in any of the products mentioned in this article nor is she a paid consultant for any companies mentioned.
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