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Poor
HAART Adherence Among Women Fuels Gender Differences in HIV Rebound
The
marked gender differences in HIV-1
RNA rebound after viral suppression that are observed in many
clinical settings may be largely explained by lower levels of antiretroviral
drug adherence among women. Injection
drug use among women also appears to play a role, according
to a new report from clinicians at the British Columbia Centre for
Excellence in HIV/AIDS in Vancouver.
Rates of HIV-1 RNA rebound within 1 year of highly active antiretroviral
therapy (HAART)-induced viral suppression have been documented in
up to half of all patients taking HAART, and women are particularly
at risk, Dr. Evan Wood and colleagues note in the December 1st issue
of the Journal of Acquired Immune Deficiency Syndromes.
They studied the association between gender and time to HIV-1 RNA
rebound in 844 men and 126 women who achieved HIV-1 RNA viral suppression
at least once after initiating HAART between August 1, 1996 and
July 31, 2000. The patients were followed until March 31, 2002.
Overall rates of viral rebound were higher in women than in men (47.4%
vs 34.0%), and this was primarily attributed to incomplete adherence
to antiretroviral therapy, which was more common in women than in
men, the investigators report.
As Dr. Wood explained in comments to Reuters Health, "the majority
of men on HAART are gay and bisexual and have higher adherence whereas
women tend to have a history of injection drug use, and it is known
that injection drug users have
"Our findings suggest that psychological factors such as drug
use and incomplete adherence predict HIV-1 RNA rebound and that
gender differences in time to rebound can be largely attributed
to a disproportionate prevalence of these factors among women in
this population," the authors conclude.
"Overall, the findings reinforce the need for adherence interventions
for injection drug users," Dr. Wood added.
01/07/05
J
Acquir Immune Defic Syndr 2004;37:1470-1476.
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