February 24, 2009

Being Female Linked to Poorer Survival

HIV-positive women have a higher likelihood of premature death from any cause compared with HIV-positive men, according to a study published online February 16 in The Journal of Infectious Diseases. A person’s race or history of substance use was not associated with an increased risk of death.

Early in the epidemic, studies suggested that an HIV-positive person’s sex and race influences survival, with both female and black patients having higher rates of death at younger ages than male or white patients. Later studies, which controlled for such factors as access to experienced health care providers and the best HIV treatment, appeared to diminish those differences in survival.

To determine the influence of race and sex on survival in the modern treatment era, Diana Lemly, MD, from the Vanderbilt University School of Medicine in Nashville and her colleagues examined the medical records of 2,605 HIV-positive patients from the university’s Comprehensive Care Center. Patients were treated between 1998 and 2005. Twenty-four percent of the patients were female, and 38 percent were black.

In general, black patients tended to present for care with lower CD4 cell counts and were less likely than white patients to have been on antiretroviral (ARV) therapy before being seen at the clinic. Female patients tended to be younger than male patients and to enter care with higher CD4 counts. The average follow-up was just over two years. A total of 253 deaths occurred during the study period.

After controlling for the total amount of time that a person spent taking ARV therapy, researchers found that women, older patients and people with low CD4 counts before starting ARV treatment all had a higher risk of death than men, younger patients and people who started treatment with higher CD4 counts. Black patients also had a higher death rate than white patients, but this was due to their being less likely to start ARV therapy and stay on therapy.

Lemly and her colleagues speculate that the higher risk of premature death in women may be due to factors such as poorer adherence, higher rates of depression and lack of social support rather than biological differences.

Search: Women, female, black, race, survival, Diana Lemly, Vanderbilt University

Scroll down to comment on this story.

Previous Comments: