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By Amy Norton
NEW YORK, Mar 07 (Reuters Health) - Doctors may need to reevaluate how they decide when to start HIV-positive women on antiretroviral drugs, researchers suggest. Women generally have lower levels of the virus in their blood compared with men, but they progress to AIDS just as quickly, according to new study findings.
This suggests that for women, the decision on when to start anti-HIV drugs should be based on their T cell counts rather than the amount of virus in their blood, Dr. Timothy R. Sterling told Reuters Health.
Sterling, of Johns Hopkins University in Baltimore, Maryland, led a study of about 200 HIV-positive men and women that confirmed previous reports of women having lower initial viral levels after HIV infection.
It also showed that despite these lower amounts of HIV in the blood, women develop AIDS as quickly as men do. If treatment decisions are based solely on viral levels, according to Sterling, women will generally start on therapy later in the course of infection than men do.
He and his colleagues report their findings in the March 8th issue of The New England Journal of Medicine.
Over 10 years, Sterling's team followed 202 injection-drug users after they had been diagnosed as HIV-positive. Every 6 months, the researchers measured the patients' levels of HIV and T cells--immune system cells that HIV destroys as the infection progresses. Most of the patients refused treatment, Sterling noted. But had they started therapy according to their viral levels, 74% of the men would have been on antiretroviral drugs within months of testing HIV positive, compared with 37% of women, the report indicates.
On the other hand, T cells counts--and, therefore, progression to AIDS--did not differ significantly between men and women. HIV treatment guidelines state that doctors may start HIV drugs based on either patients' viral levels or T cell counts, Sterling explained.
"But," he said, "there's a sex difference in eligibility for treatment if you base it on viral count." So, according to Sterling, T cell counts should weigh more heavily in women's treatment.
It is unclear why women progress to AIDS as quickly as men do despite their lower initial HIV levels, Sterling told Reuters Health. But, he said, it is important to investigate whether certain factors, such as hormones, determine the difference.
SOURCE: The New England Journal of Medicine 2001;344:720-725.
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