Study: Sex, Race and Location May Influence HIV Outcomes

Despite comparatively favorable clinical parameters at enrollment, women with HIV developed worse outcomes than men in a 1997-2007 study of a primarily North American cohort of recently and acutely infected patients. The study was based on 2,277 HIV seroconverters, including 124 women, enrolled in the Acute Infection and Early Disease Research Program.

Among the study findings:

• Initially, women averaged .40 log10 fewer copies/mL of HIV-1 RNA (P
• Nonwhite men and women were less likely to initiate antiretroviral therapy (ART) at any time than white men (P
• Patients in the US South were less likely to initiate ART compared with those in other regions (P=.047).
• Women were 2.17-fold more likely than men to experience at least one HIV/AIDS-related illness (P
• Eight years after diagnosis, 78 percent of nonwhite and 37 percent of white patients in the South had reported at least one HIV/AIDS-related illness, compared with 24 percent of whites and 17 percent of nonwhites from other regions (P

"To me that's just incredible," said lead author Dr. Amie Meditz of the University of Colorado-Denver. "We have to figure out why this group had poor outcomes, and we have to develop strategies on how to fix this."

"Despite striking advances in the treatment of HIV-infection, this study points out that there are other factors that are beyond the sphere of science, medicine, and the health care system that can substantially impact the health outcome of HIV-infected individuals," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which funded the study. "Paramount among these is the influence of socioeconomic factors that often determine access to health care as well as contribute in a negative way to a lifestyle detrimental to optimal health outcomes in the acquisition and treatment of a number of diseases, including HIV infection."

The full study, "Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection," was published in the Journal of Infectious Diseases (2011;203(4):442-451).

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