Can Gender Affect ART Responses in HIV-1 Positive Individuals?
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SAN DIEGO—Gender does not appear to modulate antiretroviral therapy (ART) responses among people with treatment-naïve HIV-1 infection, according to a study reported at IDWeek 2017.
“In our study, gender was not found to be associated with differences in response to ART,” reported Andrea Reyes Vega, MD, of the Division of Infectious Diseases at the University of Louisville in Louisville, KY.
The possibility of gender differences in virologic response to ART among HIV-positive, treatment-naïve individuals remains controversial, Dr. Vega reported. The study authors sought to contribute to the evidence base on gender differences in virologic and immunologic responses to ART in this patient population.
They conducted a retrospective, observational study patients managed at the 550 Clinic who began ART between January 2010 and December 2015. Patients were included in the study if their viral load and CD4 counts before and 1 year of initiating ART were available.
Virologic success was defined as <48 HIV-1 RNA copies/mL, and immunologic recovery was defined as a CD4 count increase of ≥150 cells/mm3.
A total of 74 women and 116 men were included in the study. Median age was significantly higher for the women than men (41 vs. 33 years; P<0.001), Dr. Reyes Vega cautioned. The majority of male patients were homosexual (72% vs. 0%; P<0.001) whereas almost all of the female patients were heterosexual (99% vs. 42%; P<0.001).
Virologic suppression was documented in 76% of the women and 66% of the men, but this difference was not statistically significant (P=0.196, n.s.). Immune recovery was also similar between women and men (62% vs. 65%; P=0.759, n.s.). About half of the female and male patients were current tobacco users (53%; P>0.999) and the percentage of patients who were current drug users were also similar (35% male vs. 31% female; P=0.637).
The breakdown by ART type among males was as follows: integrase strand transfer inhibitor (INSTI) regimen (38%), non-nucleoside reverse transcriptase inhibitors (NNRTI) regimen (28%), and protease inhibitor (PI) regimen (34%). The breakdown by ART type among females was as follows: INSTI regimen (41%), NNRTI regimen (24%), and PI regimen (43%). Medication compliance was similar between males and females (86% vs. 85%; P=0.834)
A CD4/CD8 ratio >1 was observed in 40% of women vs. 26% of men (P=0.081). Moreover, resistance in baseline genotype was seen in just 5 women, all of whom had viral load <20 copies/mL at the 1-year follow-up point. In men, resistance in baseline genotype was seen in 17 patients, of which 13 had viral load <20 copies/mL at the 1-year follow-up.
Dr. Vega added, "White race was found to be an independent risk factor for achieving viral load suppression, supporting other disparities described among people living with HIV."
The findings indicate PI-based regimens had a "higher likelihood of reaching better immunologic recovery compared to INSTI- or NNRTI-based regimens" and that males were independently associated with higher odds of reaching a CD4/CD8 ration >1 at the 1-year follow-up. "Studies assessing particular barriers and needs affecting HIV-positive women are needed in order to improve care in this population," concluded Dr. Vega.
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Vega AR, Loban A, Srinivasan K, Furmanek S, English C, Bishop M, Spencer C, Truelove D, Ramirez J, Raghuram A, Peyrani P. Gender differences in virologic response after antiretroviral therapy in treatment-naïve HIV-infected individuals: Results from the 550 Clinic HIV Cohort Study. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. http://www.idweek.org.