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Gender differences in clinical, immunological, and virological outcomes in highly active antiretroviral-treated HIV-HCV coinfected patients.

Emery J, Pick N, Mills EJ, Cooper CL - Patient Prefer Adherence (2010)

Bottom Line: There are subtle differences in the characteristics of female and male HIV-HCV coinfected patients that influence HIV treatment decisions.The reasons for treatment interruption and change differ by biological sex.This knowledge should be considered when starting HIV therapy and in efforts to improve treatment outcomes.

View Article: PubMed Central - PubMed

Affiliation: The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Ottawa, Canada;

ABSTRACT

Objective: The influence of biological sex on human immunodeficiency virus (HIV) antiretroviral treatment outcome is not well described in HIV-hepatitis C (HCV) coinfection.

Methods: We assessed patients' clinical outcomes of HIV-HCV coinfected patients initiating antiretroviral therapy attending the Ottawa Hospital Immunodeficiency Clinic from January 1996 to June 2008.

Results: We assessed 144 males and 39 females. Although similar in most baseline characteristics, the CD4 count was higher in females (375 vs 290 cells/muL). Fewer females initiated ritonavir-boosted regimens. The median duration on therapy before interruption or change was longer in males (10 versus 4 months) (odds ratio [OR] 1.40 95% confidence interval: 0.95-2.04; P = 0.09). HIV RNA suppression was frequent (74%) and mean CD4 count achieved robust (over 400 cells/muL) at 6 months, irrespective of sex. The primary reasons for therapy interruption in females and males included: gastrointestinal intolerance (25% vs 19%; P = 0.42); poor adherence (22% vs 15%; P = 0.31); neuropsychiatric symptoms (19% vs 5%; P = 0.003); and lost to follow-up (3% vs 13%; P = 0.08). Seven males (5%) and no females discontinued therapy for liver-specific complications. Death rate was higher in females (23% vs 7%; P = 0.003).

Conclusion: There are subtle differences in the characteristics of female and male HIV-HCV coinfected patients that influence HIV treatment decisions. The reasons for treatment interruption and change differ by biological sex. This knowledge should be considered when starting HIV therapy and in efforts to improve treatment outcomes.

No MeSH data available.


Related in: MedlinePlus

Comparison of cumulative survival by sex.Abbreviations: CI, confidence intervals; HAART, highly-active antiretroviral therapy; OR, odds ratio.
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f2-ppa-4-097: Comparison of cumulative survival by sex.Abbreviations: CI, confidence intervals; HAART, highly-active antiretroviral therapy; OR, odds ratio.

Mentions: Mortality analysis revealed an association between female sex and reduced cumulative survival (odds ratio [OR] = 4.46, 95% confidence intervals [CI]: 1.8–11.0; P = 0.001) (Figure 2). When controlled for IDU, race, and baseline CD4, this association remained significant. Twenty-three percent of women and 7% of men died during the period of evaluation (P = 0.003). Sixty percent of deaths were end-stage liver disease-related and did not differ by sex.


Gender differences in clinical, immunological, and virological outcomes in highly active antiretroviral-treated HIV-HCV coinfected patients.

Emery J, Pick N, Mills EJ, Cooper CL - Patient Prefer Adherence (2010)

Comparison of cumulative survival by sex.Abbreviations: CI, confidence intervals; HAART, highly-active antiretroviral therapy; OR, odds ratio.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2875719&req=5

f2-ppa-4-097: Comparison of cumulative survival by sex.Abbreviations: CI, confidence intervals; HAART, highly-active antiretroviral therapy; OR, odds ratio.
Mentions: Mortality analysis revealed an association between female sex and reduced cumulative survival (odds ratio [OR] = 4.46, 95% confidence intervals [CI]: 1.8–11.0; P = 0.001) (Figure 2). When controlled for IDU, race, and baseline CD4, this association remained significant. Twenty-three percent of women and 7% of men died during the period of evaluation (P = 0.003). Sixty percent of deaths were end-stage liver disease-related and did not differ by sex.

Bottom Line: There are subtle differences in the characteristics of female and male HIV-HCV coinfected patients that influence HIV treatment decisions.The reasons for treatment interruption and change differ by biological sex.This knowledge should be considered when starting HIV therapy and in efforts to improve treatment outcomes.

View Article: PubMed Central - PubMed

Affiliation: The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Ottawa, Canada;

ABSTRACT

Objective: The influence of biological sex on human immunodeficiency virus (HIV) antiretroviral treatment outcome is not well described in HIV-hepatitis C (HCV) coinfection.

Methods: We assessed patients' clinical outcomes of HIV-HCV coinfected patients initiating antiretroviral therapy attending the Ottawa Hospital Immunodeficiency Clinic from January 1996 to June 2008.

Results: We assessed 144 males and 39 females. Although similar in most baseline characteristics, the CD4 count was higher in females (375 vs 290 cells/muL). Fewer females initiated ritonavir-boosted regimens. The median duration on therapy before interruption or change was longer in males (10 versus 4 months) (odds ratio [OR] 1.40 95% confidence interval: 0.95-2.04; P = 0.09). HIV RNA suppression was frequent (74%) and mean CD4 count achieved robust (over 400 cells/muL) at 6 months, irrespective of sex. The primary reasons for therapy interruption in females and males included: gastrointestinal intolerance (25% vs 19%; P = 0.42); poor adherence (22% vs 15%; P = 0.31); neuropsychiatric symptoms (19% vs 5%; P = 0.003); and lost to follow-up (3% vs 13%; P = 0.08). Seven males (5%) and no females discontinued therapy for liver-specific complications. Death rate was higher in females (23% vs 7%; P = 0.003).

Conclusion: There are subtle differences in the characteristics of female and male HIV-HCV coinfected patients that influence HIV treatment decisions. The reasons for treatment interruption and change differ by biological sex. This knowledge should be considered when starting HIV therapy and in efforts to improve treatment outcomes.

No MeSH data available.


Related in: MedlinePlus