 |
115
Natural History of HIV-1 Infection in Women—Findings from the Women’s Interagency HIV Study
R M Greenblatt
Univ of California, San Francisco
|
Background: AIDS cases among women in the U.S. continue to increase at a rate that exceeds increases among other demographic groups. Sex dimorphism exists in the natural history (including treated natural history) of HIV infection. The Women’s Interagency HIV Study (WIHS) is the largest domestic cohort study of women living with HIV and has, over the last decade, identified key features of HIV infection in women.
Methods: The WIHS is a multi-site, longitudinal, observational study of the effects of HIV and related conditions on women. Initial enrollment of 2,658 HIV infected and uninfected women occurred between 1993–1994 at 6 locations in the U.S. Interviews, physical examinations, and specimen collection are performed at each biannual study visit. Study evaluations include key medical history events, antiretroviral treatment use, plasma HIV RNA, lymphocyte subsets, cervical and anal cytology, cervical colposcopy, and body habitus measurements. Medical record and registry verification are obtained for key outcomes.
Results: WIHS participants are a racially diverse group of women who, in general, live in poverty, experience high rates of concurrent conditions ranging from hepatitis C and herpes simplex virus infections to depressive symptoms and domestic violence. Plasma HIV RNA levels among WIHS participants are lower than those among the male participants of the MACS study when stratified by CD4 cell count and vary with the ovulatory cycle. Loss of subcutaneous fat in the extremities is common among antiretroviral treated and untreated HIV-infected participants, but not among uninfected women. Low-grade cervical intraepithelial lesions predominate, but anal lesions are at least as common. Antiretroviral regimen switching and discontinuation are common, as is reporting of adverse effects of treatment. Virologic rebound during antiretroviral treatment is common.
Conclusions: In the U.S., women living with HIV infection, and those who at high risk for it, remain a demographically distinctive group. Concurrent medical and social conditions are common, and interruptions and failures in antiretroviral therapies are common. Special attention to the medical and social needs of this patient population are indicated.
|
