703 No Gender Differences in Progression of HIV-related Neurological Disease C. Hall*, W. Robertson, S. Fiscus, K. Robertson Univ of North Carolina, Chapel Hill
Background: Plasma HIV RNA copy number is a strong prognostic marker of progression to AIDS, but a recent meta analytic study by Napravnik, Eron et al., 2002, found that women at a comparable disease stage have lower HIV RNA than men. This suggests that a comparable viral burden may be more detrimental to health in women than in men. Early retrospective chart reviews have reported a higher incidence of HIV related neurological disease in women than men. Given these reports, it is possible that gender differences exist in HIV-related neurological disease progression. To address this question, we have recently completed a longitudinal study evaluating differences in neurological disease between genders.
Methods: Female HIV+ (48), female HIV- (48), and male HIV+ (52) subjects were followed annually for this longitudinal study. All subjects underwent standardized neurological exams by a neurologist, who rated neurologic function with particular focus on peripheral neuropathy and AIDS Dementia, and in-depth psychological and neuropsychological exams supervised by a neuropsychologist. Ultra sensitive (Roche Monitor) assays for HIV RNA were completed on plasma and CSF.
Results: Analyses were completed for baseline (n = 148), year 1 (n = 106), year 2 (n = 80), and year 3 (n = 53). The male and female HIV+ groups were comparable in immune functioning; no differences were found in mean absolute CD4+ cell count (266 [SD = 244] vs 315 [SD = 238], ns). The groups were comparable in systemic viral load as measured by plasma HIV RNA, males 3.31 (SD = 1.88) females 3.36 (SD = 1.98) log cps/ml, ns. The groups were also comparable in CSF HIV RNA, (males 1.53 [SD = 1.64] log cps/ml; females 1.47 [SD = 1.60] log cps/ml, ns).
Differences in neuropsychological functioning (F [1,167] = 11.74, p < 0.001), but not in neurological exam (F [1,164] = 1.27, ns) were found between HIV+ and HIV- females. After controlling for the relevant covariates of HIV RNA, disease stage and education, no differences were found between HIV+ females and males in neurological exam (F [1,132] = 0.08, ns) or neuropsychological functioning (F [1,134] = 2.79, ns).
Conclusions: Previous reports of gender differences were largely based on retrospective chart reviews, which can be problematic. In this prospective longitudinal study, when controlling for relevant factors such as antiretroviral use, we found no evidence that nervous system decline was more likely in one gender than the other.
