The Role of Gender in HIV Progression

Ross G. Hewitt, MD; Nader Parsa, PhD; Lawrence Gugino, MD


AIDS Read. 2001;11(1) 

In This Article

Abstract and Introduction

Recent studies have examined the experience of women and the potential for gender differences with respect to HIV progression and the acceptance, tolerance, adherence, and response regarding HAART. Differences in CD4 cell count and viral load have not been reported in all studies. For any given CD4 cell count, women may be at a higher risk of HIV progression. Women appear to have an increased risk of progression to AIDS compared with men with the same viral load. They have lower initial viral loads than men in early-stage disease, but these catch up in advanced-stage disease. Because of depression and other psychological factors, women may be in greater need of supportive services, and this can affect the success of antiretroviral therapy. Women also have an increased risk of adverse drug reactions from HAART. Gender should be considered when prescribing therapy.

Knowledge of the natural history of HIV infection is based primarily on the studies of men, and the applicability of this information to women is unclear.[1,2,3,4,5,6] In the era before HAART, evaluation of HIV disease progression focused mainly on survival. Retrospective epidemiologic studies have reported shorter survival periods and an increased relative risk of death for women with AIDS, compared with the relative risk of death for men with AIDS.[7,8,9] This difference was believed to be due to the social issue of access to care, as opposed to biologic factors related to gender.[10]

The introduction of HIV-specific RNA (or viral load) measurements and the use of HAART in clinical practice have led to a reexamination of the potential for gender differences. Availability of viral load testing has also led to further study of the biologic effects of cytokines, hormones, and the menstrual cycle on viral replication and, ultimately, on HIV progression. As experience accumulates with HAART, the potential for gender differences also exists with respect to acceptance, tolerance, adherence, and response. This article will review the emerging data that explore the role of gender in HIV progression.


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