Specific Adverse Effects of Antiretroviral Therapy Vary Depending on Race, Gender, Study Says

Although the overall rate of adverse events among HIV-positive people initiating antiretroviral treatment does not differ significantly among different races and genders, there are significant differences in the incidence of specific adverse events, according to a study recently published in the Journal of Acquired Immune Deficiency Syndromes, Reuters Health reports. For the study, Ellen Tedaldi of Temple University's School of Medicine and colleagues compared the frequency and types of adverse effects among 1,301 patients who were initiating antiretroviral therapy. The study included 701 black participants, 225 Latinos and 273 women. The study did not find significant differences among races or gender in regard to death from any cause or treatment withdrawal rates because of drug toxicity (Reuters Health, 4/30).

According to the study, several "baseline characteristics" differed based on gender and race -- including age, HIV transmission risk, hepatitis B or C coinfection, viral load, diagnosis of AIDS, body mass index and baseline hypertension (Tedaldi et al., JAIDS, 4/1). Cardiovascular and kidney side effects were 2.64 and 3.83 times more frequent, respectively, among the black participants than among white participants, the study found. This finding was consistent with the increased rates of heart disease, diabetes and kidney disease found among all black men and women, the researchers noted.

Black men experienced 2.45 times higher rates of psychiatric-related adverse events than white men, the study showed. Tedaldi and her team said that it is "likely that grade four psychiatric adverse events represent a constellation of factors that include psychosocial and biologic associations," such as undiagnosed mental illness or the virus' effects on the central nervous system.

The study found 409 grade four adverse events during an average five-year follow-up period, or a rate of 8.9 events per person per 100 years. Grade four events are considered the most severe types based on a scale of one to four. The study found that women were 2.34 times more likely to experience grade four anemia, compared with men, according to the study. This finding was "not unexpected" because most of the women were premenopausal and black, the researchers wrote. Researchers also recorded 176 deaths -- a rate of three per person per 100 years. The study also recorded 523 antiretroviral discontinuations for any toxicity -- a rate of 13 per person per 100 years.

The researchers note that published data on the rate and types of adverse events by gender and race are limited, concluding that the findings "could inform HIV treating clinicians about particular issues to consider in the selection of antiretroviral regimens for diverse populations" (Reuters Health, 4/30).

The study abstract is available online.

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