The Role of Gender in HIV Progression

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

Disclosures

AIDS Read. 2001;11(1) 

In This Article

Biologic Differences

Estrogens and progestins appear to have immunoregulatory effects through production of cytokines.[17] Luteinizing hormone may increase the percentage of circulating CD4 cells, while follicle-stimulating hormone may decrease the percentage of CD4 cells but increase the percentage of CD8 cells.[18] Combined oral contraceptive pill use was found to be associated with a trend toward a lower absolute CD4 cell count.[19] High serum prolactin levels were found to be associated with symptomatic versus asymptomatic HIV infection, regardless of gender, CD4 cell count, or degree of viral suppression.[20]

In a prospective study, nearly two thirds of HIV-infected women reported irregular periods, and 15% noted spotting or abnormal bleeding.[21] However, there was no statistical difference in these symptoms compared with those of HIV-negative controls. In another prospective study requiring completion of monthly diaries by 802 HIV-infected women and 273 HIV-negative women, infection was associated with very short menstrual cycles (less than 18 days) (odds ratio [OR], 1.41; 95% confidence interval [CI], 0.98 to 2.02).[22] Yet, HIV status did not correlate with mean length or variability of standard cycles; in general, the possibility of having short cycles was only slightly increased. In a group of ovulating women in whom HIV RNA levels were measured weekly, the median HIV RNA level fell by 0.16 log10 from the early follicular phase to the midluteal phase.[23] Women who did not ovulate had no change in median HIV RNA levels.

In the pre-HAART era, lower CD4 cell counts were reported during pregnancy, with a significant increase before and after delivery in healthy and HIV-infected women.[24] Among HIV-infected women, the decline in CD4 cell counts during pregnancy was similar to that of noninfected women, but prepartum levels were increased and postpartum levels were reduced. In a prospective cohort study that compared pregnant HIV-infected women with nonpregnant HIV-infected women during follow-up, the rate of any AIDS-defining event was higher in pregnant women but did not reach statistical significance.[25] Considering CD4 cell counts before conception, acceleration of disease progression is inconsistent among HIV-infected women who become pregnant during follow-up. In a prospective European study, pregnancy did not affect CD4 cell count decline after seroconversion.[26]

When compared with HIV-seropositive men who abuse drugs, HIV-seropositive women who abuse drugs exhibited significantly poorer overall nutritional status (defined by low prealbumin levels) in the pre-HAART era.[27] In addition, women had low retinol binding protein levels and low selenium levels. In women with CD4 cell counts below 200/µL, significantly lower levels of vitamin A, vitamin E, and selenium were observed, compared with the levels found in men. Such nutritional deficiencies may contribute to HIV progression.

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