Initial Plasma HIV-1 RNA Levels and Progression to AIDS in Women and Men
Timothy R. Sterling, M.D., David Vlahov, Ph.D., Jacquie Astemborski, M.H.S., Donald R. Hoover, Ph.D., M.P.H., Joseph B. Margolick, M.D., Ph.D., and Thomas C. Quinn, M.D.
Background It is unclear whether there are differences betweenmen and women with human immunodeficiency virus type 1 (HIV-1)infection in the plasma level of viral RNA (the viral load).In men, the initial viral load after seroconversion predictsthe likelihood of progression to the acquired immunodeficiencysyndrome (AIDS), but the relation between the two has not beenassessed in women. Currently, the guidelines for initiatingantiretroviral therapy are applied uniformly to women and men.
Methods From 1988 through 1998, the viral load and the CD4+lymphocyte count were measured approximately every six monthsin 156 male and 46 female injection-drug users who were followedprospectively after HIV-1 seroconversion.
Results The median initial viral load was 50,766 copies of HIV-1RNA per milliliter in the men but only 15,103 copies per milliliterin the women (P<0.001). The median initial CD4+ count didnot differ significantly according to sex (659 and 672 cellsper cubic millimeter, respectively). HIV-1 infection progressedto AIDS in 29 men and 15 women, and the risk of progressiondid not differ significantly according to sex. For each increaseof 1 log in the viral load (on a base 10 scale), the hazardratio for progression to AIDS was 1.55 (95 percent confidenceinterval, 0.97 to 2.47) among the men and 1.43 (95 percent confidenceinterval, 0.76 to 2.69) among the women. The median initialviral load was 77,822 HIV-1 RNA copies per milliliter in themen in whom AIDS developed and 40,634 copies per milliliterin the men in whom it did not; the corresponding values in thewomen were 17,149 and 12,043 copies per milliliter. Given therecommendation that treatment should be initiated when the viralload reaches 20,000 copies per milliliter, 74 percent of themen but only 37 percent of the women in our study would havebeen eligible for therapy at the first visit after seroconversion(P<0.001).
Conclusions Although the initial level of HIV-1 RNA was lowerin women than in men, the rates of progression to AIDS weresimilar. Treatment guidelines that are based on the viral load,rather than the CD4+ lymphocyte count, will lead to differencesin eligibility for antiretroviral treatment according to sex.
Source Information
From the Department of Epidemiology (T.R.S., D.V., J.A.) and the Department of Molecular Microbiology and Immunology (J.B.M.), Johns Hopkins University School of Public Health, Baltimore; the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (T.R.S, D.V., J.A., T.C.Q.); the Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York (D.V.); the Department of Statistics, Rutgers University, Piscataway, N.J. (D.R.H.); and the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (T.C.Q.). Presented in part at the 13th International AIDS Conference, Durban, South Africa, July 9–14, 2000.
Address reprint requests to Dr. Sterling at the Division of Infectious Diseases, 1830 E. Monument St., Rm. 444, Baltimore, MD 21287, or at tsterls{at}jhmi.edu.
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