African Americans were more likely to experience serious heart- and kidney-related side effects than Caucasians after starting antiretroviral therapy, and women had more anemia than men, say authors of a study published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS).
Ellen Tedaldi, MD, from the Temple comprehensive HIV program at the Temple University School of Medicine in Philadelphia, and her colleagues enrolled 1,301 HIV-positive participants in a five-year safety and efficacy study through the Community Programs for Clinical Research on AIDS (CPCRA). The study enrolled HIV-positive patients starting therapy for the first time to receive one of three treatment combinations: a protease inhibitor (PI)-based regimen, a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen, and a regimen consisting of both a PI and an NNRTI. For the analysis published in JAIDS, Tedaldi’s team reexamined the original data to determine whether there were any racial or sex differences in response to treatment or the frequency of certain side effects.
Tedaldi’s team enrolled 701 people who identified as African American, 225 people who identified as Latino and 375 people who identified as either Caucasian or other race; 263 of the participants were women. There were some minor differences in characteristics at the beginning of the study. For instance, African Americans were more likely to enter the study with a lower CD4 count and an AIDS diagnosis. Men were more likely to be coinfected with hepatitis B than women. The most commonly used PI was Viracept (nelfinavir), and the most commonly used NNRTI was Sustiva (efavirenz). The majority of the participants took Retrovir (zidovudine) and Epivir (lamivudine) as their nucleoside reverse transcripase inhibitor (NRTI) backbone.
Neither race nor gender appeared to have any impact on how well people responded to treatment, in terms of viral load reductions and CD4 cell count gains. Also, there did not appear to be gender or race differences in side effects that were attributable to one drug or combination of drugs.
When the researchers accounted for participant characteristics at study entry—such as history of diabetes, or high blood pressure—African Americans were still about twice as likely as Caucasian or Latino participants to experience heart- or kidney-related side effects. As African Americans in the general population suffer from heart and kidney problems more than Caucasians, this result was not unexpected.
African-American men were more likely than all other participants to report psychiatric side effects. This difference was not related to the type of antiretroviral treatment that the participants took, and it was a finding that surprised researchers, as other studies have shown that women most often report adverse effects like depression. The one side effect that differed between the sexes was anemia, occurring in twice as many women as men. This is consistent with other studies of antiretrovirals that have found that women suffer from anemia more commonly than men.
