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How HIV/AIDS affects women differently
by Katherine Stapp Inter Press Service (IPS) Source: AEGIS 1/10/02 Reposted courtesy of GENDER-AIDS ([email protected])
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With women now constituting nearly half of all people living with HIV and AIDS around the world, more studies are focusing on how to tailor treatment to their specific health issues.
Since the introduction of highly active anti-retroviral therapy (HAART), the AIDS death rate in the United States has fallen dramatically. In 1995, AIDS was the third leading cause of death among women. By 1999, it was the fifth.
Still, the reduction in AIDS deaths among women has not been as great as among men. This gap is due in part to the fact that women remain less likely to get drug treatment. But gender differences may also affect the way HIV infections progress, response to antiretroviral therapy and lead to complications of therapy, researchers say.
For example, a recent study by Timothy Sterling of the Johns Hopkins School of Medicine found that women newly diagnosed with HIV have one-third less of the virus in their blood than their male counterparts. That difference did not affect the course of the disease, and women eventually developed AIDS in equal numbers.
"We're still unclear why there is this difference in viral loads early on," said Sterling. "It's a question that requires further research." The findings are important because they supported changes in guidelines for doctors about when to start drug therapy.
Sterling's co-author, Thomas Quinn, also a professor at Johns Hopkins, noted that "previous studies in men have shown that initial viral load can be used to gauge their likelihood of progression to AIDS, but these data confirm that the initial viral load is much lower in women than in men and consequently not as predictive for women".
Sterling said the women in the study also had a higher level of CD4 cells, or helper T-cells, which fight off opportunistic infections. CD4 cells are a major target of the HIV virus, and serve as a laboratory gauge of the health of a person's immune system.
How women respond to anti-retroviral drugs is a key area of research, advocates say. Since HAART has been effective in prolonging HIV-positive women's lives, more research is needed to investigate how the disease progresses. One study, dubbed ACTG 175 and supported by the U.S. National Institutes of Health (NIH), found that women needed to have their drug doses adjusted sooner than men, and that women were more likely to experience severe HIV symptoms.
Another study published in recent months by the Emory University Center for AIDS Research concluded that women suffered significantly more side effects from HAART therapy than men, including neurological complications and lipodystrophy, a metabolism malfunction that results in altered distribution of body fat.
"Considering the complex combinations of antiretrovirals and the serious lack of data, there is a dire need to (further) assess the use of these drugs in women," said Debra Johnson, an investigator with the University of Southern California's clinical trials unit and an expert in the treatment of women with HIV.
"Drug dosing, absorption, efficacy and toxicity are likely to be affected by differences in hormones, weight and body composition between men and women."
Much of the current work to answer these questions is being carried out by the Women's Inter-Agency HIV Study, a long-term project supported by the NIH. Launched in 1993, the WIHA has enrolled about 2600 women so far and is poised to expand by another 1100.
Areas of WIHA research include women-specific outcomes in HIV, hepatitis C, human papilloma virus, reproductive health, lipodystrophy, the impact of drugs on lowering viral load, and the effect of hormones on HIV progression.
"The beauty of this study is that it represents the current face of the AIDS epidemic," said Carl Dieffenbach of the National Institute for Allergy and Infectious Diseases, noting that about 80 percent of the participants are African-American and Latina. Some 80-85 percent of the women are on HAART therapy, compared to 90-95 percent of the men.
Dieffenbach attributed this gap to the special stresses experienced by women, many of whom must juggle childcare, housing issues, financial pressures and a complex drug schedule.
"Sometimes their lives are so complicated they just can't deal," he said. One finding so far is that while available drugs have proven equally effective in suppressing the HIV virus in women and men, women tend to switch therapies more often possibly because they experience a higher rate of side effects.
"It's possible that women have more side effects because the dosing is scaled to lean body mass," Dieffenbach said. "We're looking at female-specific pharmacology, specifically at the dosing. We've done some studies in that area, which will be expanded in the next few years."
One of the biggest victories for women living with HIV/AIDS has been the development of drugs to prevent mother-to-child transmission of the virus. Since 1991, the number of U.S. babies born with HIV has plummeted by 80 percent, and drugs like Nevirapine and Zidovudine are increasingly being made available in the hardest-hit parts of the world.
(END/IPS/NA/HE/HD/KS/AN/ML/02) . 021001 IP021002
For more information, visit: http://ww2.aegis.org/news/ips/2002/IP021002.html |
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