Women, Southerners Have Highest HIV Infection Rates

Carole Bullock

January 27, 2011

January 27, 2011 — Women, nonwhites, and Southerners who were newly diagnosed with HIV and followed for an average of 4 years were more likely to die than their sex- and regional-matched counterparts, researchers report in the February 15 issue of the Journal of Infectious Diseases.

Multicenter data were collected from more than 2000 North American patients in the Acute Infection and Early Disease Research Program, funded by the National Institute of Allergy and Infectious Diseases (NIAID), which ran from 1997 until 2007.

Eligible patients were newly diagnosed with HIV-1 (defined as having disease for at least 1 year); they were followed for a mean of 4 years. Most of the men in the study were white, whereas most of the women were nonwhite and came from the South (79%).

One or more HIV/AIDS-related events occurred in 78% of nonwhites and in 37% of whites from the South, compared with 17% of nonwhites and 24% of whites from other regions after 8 years.

"Race and region play important roles. Women were 2.17-fold more likely to experience more than 1 HIV/AIDS-related event than men, and nonwhite women were most likely to experience an HIV/AIDS-related event, compared with all others," first author Amie L. Meditz, MD, from the University of Colorado, Denver, reported.

Nonwhite women and men and those from the South were "not as likely to initiate antiviral therapies," she added.

Although a less aggressive antiretroviral therapy approach could explain some of the "Southern gap" behavior, lifestyle, environment, access to care, and other socioeconomic factors must be considered, concluded Dr. Meditz.

The NIAID team reports that the study had one big surprise: at diagnosis, women had lower viral loads and higher CD4+ T cell counts than men, yet they were still more prone to HIV-related illness.

Other findings noted after 8 years of follow-up were that 64% of nonwhite women had HIV-related infections, compared with 21% in other combined race and sex groups; that 22% of nonwhite women had AIDS-defining events, compared with 6% in other combined race and sex groups; and that race and sex differences in response to antiviral therapy were nonexistent.

In an accompanying editorial, Carlos del Rio, MD, and Wendy S. Armstrong, MD, from Emory University's Center for AIDS Research in Atlanta, Georgia, note that socioeconomics play a major role, "and represent complex challenges that are beyond the traditional influence of public health."

Dr. Meditz added that "understanding the causes of poor health outcomes among HIV-infected women, nonwhites, and people from the South is a critical first step."

J Infect Dis. 2011:203:437-438; 442-451. Abstract, Abstract


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