BMJ 1994;309:1537-1542 (10 December)

Papers

HIV disease progression in 854 women and men infected through injecting drug use and heterosexual sex and followed for up to nine years from seroconversion

Alessandro Cozzi Lepri, research statistician,,a Patrizio Pezzotti, research statistician,,a Maria Dorrucci, research statistician,,a Andrew N Phillips, senior lecturer in epidemiology and medical statistics,b Giovanni Rezza, director of research in epidemiology,a  and the Italian Seroconversion Study

a Istituto Superiore di Sanita, Laboratorio di Epidemiologia e Biostatistica, Centro Operativo AIDS, 00161 Rome, Italy,, b Royal Free Hospital School of Medicine, Department of Public Health, London NW3 2PF,

Italian Seroconversion Study Members of the study group who participated in this study are listed at the end. Correspondence and requests for reprints to: Dr Cozzi Lepri.

Abstract

Objective: To compare the progression of HIV-1 infection in men and women followed up for up to nine years after an accurately estimated date of seroconversion.
Design: Prospective observational study.
Setting: 16 HIV outpatient clinics across Italy.
Subjects: 321 women and 533 men infected with HIV through injecting drug use or heterosexual sex and with accurately estimated dates of seroconversion.
Main outcome measures: Progression to severe CD4 lymphocytopenia (CD4 lymphocyte count <200 x 106/l), development of AIDS defining diseases, and death from AIDS.
Results: Thirty two women and 67 men developed AIDS at Kaplan-Meier progression rates of 25% (95% confidence interval 13.8% to 35.5%) and 23% (15.6% to 30.4%), respectively, 7 years after seroconversion. In a Cox proportional hazards model the relative hazard was 0.93 (that is, a slightly lower hazard in women) before and 1.10 (0.70 to 1.72) after adjusting for age, HIV exposure group, and year of seroconversion. When CD4 lymphocytopenia and death from AIDS were used as end points the results were similar, with adjusted relative hazards of 0.95 (0.63 to 1.42) and 0.72 (0.48 to 1.79) respectively. In both women and men the risk of developing AIDS before the CD4 lymphocyte count had declined below 200 x 106/l was small (3% in women, 6% in men). The estimated median count at which AIDS developed in women (34 x 106/l; 10 x 106 to 44 x 106 was similar to that for men (44 x 106/l; 22 x 106 to 60 x 106.
Conclusion: There seems to be little evidence for appreciable differences in the natural course of HIV infection between men and women followed up from the time of seroconversion.

Key messages

  • Key messages

  • The number of women with HIV infection and AIDS is increasing throughout the world

  • The few studies that have compared the risks of HIV disease progression between women and men have had conflicting results due to methodological limitations

  • This study shows that the risk of progressing to AIDS, death from AIDS, and a CD4 lymphocyte count lower than 200 x 106/l after HIV seroconversion seems to be similar among women and men

  • Women may progress to AIDS at a lower CD4 count than men

  • Among opportunistic infections indicative of AIDS, disseminated cytomegalovirus infection seems to be more common among women


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