Gender-specific differences in the natural history, clinical features, and socioeconomic status of HIV-infected patients: experience of a treatment centre in Vienna

Abstract

Background: In order to evaluate natural history, clinical features, and socioeconomic aspects in HIV-infected women, a prospective study comprising 695 HIV-infected patients was performed at our department.

Methods: Demographic data, CD4+ T-lymphocyte counts, human immunodeficiency virus-1 (HIV-1) plasma loads, AIDS indicator diseases and socioeconomic variables were recorded. Prognostic factors for survival were evaluated by univariate and multivariate analysis. Data of men and women were compared.

Results: The mean age of the 150 women (29.4 +/- 9.4 years) was significantly lower than that of men (32.6 +/- 9.7 years, p = 0.0002). CD4+ T-lymphocyte counts, HIV1-plasma loads, and AIDS indicator diseases did not significantly differ between men and women; the same was true for all socioeconomic variables (family status, education, professional training, employment status) except family status. No significant difference in median overall and AIDS-free survival was observed between females (2033 and 1593 days) and males (1554.5 and 1235 days, respectively, p = 0.36 and p = 0.098). Overall survival compared by age groups (< 30, 31-50, > 50 years), by risk categories (homosexuals, i.v. drug users, heterosexual contacts) and by CD4+ T-lymphocyte count (< 200, 200-500, > 500 cells/mm3), differed significantly (p < 0.001) as did AIDS-free survival. Lower age and a high CD4+ T-lymphocyte count were independently associated with the outcome in the multivariate analysis. (Overall survival/relative risk: 0.49 for age < 30 years and 2.3 for CD4+ T-lymphocyte count < 200 cells/mm3, AIDS-free survival/relative risk: 0.65 for age < 30 years and 3.3 for CD4+ T-lymphocyte count < 200 cells/mm3). HIV-1 plasma loads as a prognostic factor could not be evaluated due to the small number of patients who died or developed AIDS (2/375 and 10/375 patients, respectively).

Conclusion: Our results showed no difference in the natural history and clinical features of HIV infection between men and women. However, pulmonary tuberculosis was associated with a significantly longer survival compared to other AIDS-defining diseases. Lower age and high CD4+ T-lymphocyte count are independent predictors for survival. With the exception of family status, socioeconomic variables showed no differences between male and female patients.