HIV-Infected Women May Need to Initiate Treatment Earlier Than Do Men

Embargoed for Release November 7, 1998

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Lisbeth Pettengill
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HIV-Infected Women May Need to Initiate Treatment Earlier Than Do Men

Researchers from the Johns Hopkins School of Public Health have shown that if an HIV- infected woman has half the viral load level (the quantity of HIV-1 virus circulating in the bloodstream) of an infected man, she will develop AIDS as quickly as he. Similarly, if an HIV- infected woman's viral load level is comparable to that of a man, she is likely to be much further along the path towards AIDS. The study appeared in this week's issue of The Lancet.

Viral load in plasma is currently used to determine when combination antiretroviral treatment should be initiated in both men and women, even though most of the data about viral load were obtained from studies of gay men. The current findings suggested that viral load's association with AIDS prognosis may have to be adjusted downward for women.

Lead author Homayoon Farzadegan, PhD, associate professor, Epidemiology, said, "Although it remains unclear why, our data suggest that the current HIV-1 viral load levels now used to signal initiation of antiretroviral therapy may have to be revised downward for women by as much as one-half."

The scientists examined blood samples from a cohort of men and women who were HIV-positive injection drug users. First, plasma specimens that had been frozen and saved several years earlier were analyzed in order to establish baseline viral load values. Then, fresh blood specimens were collected periodically and their levels of HIV-1 viral load quantified by using three different independent methods.

All three laboratory techniques showed that, at both baseline and follow-up, HIV viral load levels were significantly lower in women than in men, even after adjusting for CD4+ cell count, race, and drug use. For instance, RT-PCR revealed that the women's median baseline viral load was 3,365 copies of HIV-1 RNA per milliliter of blood, compared to 8,907 for men; at follow-up, in men and women at similar stages of the disease, women had a median of 45,416 copies versus 93,130 for men.

The study also verified that at the same degree of illness women had CD4+ cell counts comparable to those of men, and that participants' use of antiretroviral therapy did not alter the association of gender and viral load values.

The current guidelines recommend initiating therapy when plasma viral load levels are 10,000 copies per milliliter and when CD4+ cell counts are 500 cells per microliter. -end- The study was supported by a grant from the National Institute on Drug Abuse.