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December 28, 1994

Survival and Disease Progression According to Gender of Patients With HIV InfectionThe Terry Beirn Community Programs for Clinical Research on AIDS

Sandra L. Melnick, DrPH; Renslow Sherer, MD; Thomas A. Louis, PhD; et al David Hillman, MS; Evelyn M. Rodriguez, MD; Cheryl Lackman, MPH; Linnea Capps, MD; Lawrence S. Brown Jr, MD; Marcia Carlyn, PhD; Joyce A. Korvick, MD; Lawrence Deyton, MD, MSPH; Stanley Johns, MD, CTC; Jacquelyn Ellison, LPN; Micheal J. Hickson, MD; Janet Lee, MD; Melanie Thompson, MD; Terri Creagh, PhD; Amy Morris, MBA; Jerome Ernst, MD; Cathy Pollard, RPA-C; Kathryn Anastos, MD; Mordechai Bar, MD; Elizabeth Doramajian, MS; David Blatt, MD; David Moore, DO; Renee Renzetti, RN; Rita Verheggen, RN; Roberta Luskin-Hawk, MD; Ramon A. Torres, MD; David Townley; Kathleen Clanon, MD; Bea Morris, PA; William Owen, MD; Carol Brosgart, MD; Lawrence R. Crane, MD; Jack Ebright, MD; Paula Schuman, MD; William Valuer, MSW; Colleen Fairclough, RN, BN; William J. Holloway, MD; Dean Winslow, MD; Susan Szabo, MD; Arlene Bincsik, RNC, MS; Karen Swanson, RNC, BSN; David L. Cohn, MD; Randall R. Reves, MD; Michael J. Grodesky, BSN; Carol A. Mesard, RN; Joan E. Gans, BSN; Wafaa El-Sadr, MD, MPH; Linnea Capps, MD, MPH; Cheryl Guity, RN; Michelle Hardy; Luis Fuentes, MPH; Louis Saravolatz, MD; Norman Markowitz, MD; Jones Kumi, MD; Diane Mastro-Polak, RN, BSN; Jill Hutchinson, AD; Janice Walker, RN, MN; Sue Pablovich Sr, RN, NP, MPH; Phyllis Simmons, RN; Nancy Kimmel, RN; Jeffrey Kocher, MD; Steven Weisholtz, MD; Annemarie Sheridan, RN; Victoria M. Taylor, RN; Jilleen Braithwaite; James H. Sampson, MD; Joel Godbey, MD; Mark Loveless, MD; Catherine Salveson, RN; Norma Martinez, RN; Thomas M. Kerkering, MD; Carol Webster, RN, MPH; Evelyn Fisher, MD; Kurt Link, MD; Lawrence Gernon, MD; Ami Labriola, MD; Cynthia Gibert, MD; John Scott, RNC; Elizabeth Finley, RN, ANP; Karen Irvin, RN, MEd; James D. Neaton, PhD; Tim Brelje, MS; Alain DuChene; Greg Thompson; Deborah N. Wentworth, MPH; Lawrence R. Deyton, MSPH, MD; Jane Sanvffle, MPH; Mary Foulkes, PhD
Author Affiliations

From the Division of Epidemiology (Dr Melnick) and Division of Biostatistics (Dr Louis and Mr Hillman), School of Public Health, University of Minnesota, Minneapolis; Cook County HIV Primary Care Center, Cook County Hospital, Chicago, Ill (Dr Sherer); Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (Drs Rodriguez, Korvick, and Deyton); Bronx (NY) Perinatal Consortium (Ms Lackman); Division of Infectious Diseases, Columbia University/Harlem Hospital Center, New York, NY (Dr Capps); Addiction Research and Treatment Corporation, Brooklyn, NY, and Harlem Hospital College of Physicians and Surgeons, Columbia University, New York, NY (Dr Brown); and Prospect Associates, Rockville, Md (Dr Carlyn). Dr Melnick is currently with the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
Addiction Research and Treatment Corporation; AIDS Research Consortium of Atlanta, Inc.; Bronx-Lebanon Hospital Center; Chicago Community Program for Clinical Research on AIDS; Clinical Directors Network of Region II, Inc.; Community Consortium; Comprehensive AIDS Alliance of Detroit; Delaware Community Program for Clinical Research on AIDS; Denver Community Program for Clinical Research on AIDS; Harlem AIDS Treatment Group; Henry Ford Hospital; Louisiana Community AIDS Research Program; North Jersey Community Research Initiative; The Research and Education Group; Richmond AIDS Consortium; Washington Regional AIDS Program; Statistical Center; Division of AIDS

JAMA. 1994;272(24):1915-1921. doi:10.1001/jama.1994.03520240043039

Objective.  —To compare disease progression and mortality between women and men infected with human immunodeficiency virus (HIV).

Design.  —Multicenter cohort.

Setting.  —Seventeen community-based centers participating in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA).

Patients.  —A total of 768 women and 3779 men enrolled in one or more of 11 protocols between September 7, 1990, and September 30, 1993.

Main Outcome Measures.  —Survival and opportunistic events.

Results.  —The median CD4+ cell count at enrollment into the cohort was 0.240 ×109/L (240/μL) for women and 0.137 ×109/L for men (P<.001). Compared with men, women were younger (36 vs 38 years), more likely to be African American or Hispanic (78% vs 44%), and more likely to have reported a history of injection drug use (49% vs 27%). Women had been followed up for a median of 14.5 months and men for 15.5 months. The adjusted relative risk (RR) for death among women compared with men was 1.33 (95% confidence interval [CI], 1.06 to 1.67; P=.01) and for disease progression (including death) was 0.97 (95% CI, 0.82 to 1.15; P=.72). Women were at increased risk for bacterial pneumonia (RR, 1.38; 95% CI, 1.05 to 1.92) and at reduced risk for the development of Kaposi's sarcoma (RR, 0.16; 95% CI, 0.04 to 0.65) and oral hairy leukoplakia (RR, 0.54; 95% CI, 0.31 to 0.94). The increased risk of death and bacterial pneumonia for women compared with men was primarily evident among those with a history of injection drug use (RR, 1.68 for death, 95% CI, 1.20 to 2.35, P=.003; RR, 1.53 for bacterial pneumonia, 95% CI, 1.03 to 2.29, P=.04). Among patients without a history of disease progression at entry, death was the first event reported for more women than men (27.5% vs 12.2%).

Conclusions.  —Compared with men, HIV-infected women in the CPCRA were at increased risk of death but not disease progression. Risks of most incident opportunistic diseases were similar for women and men; however, women were at an increased risk of bacterial pneumonia. These findings may reflect differential access to health care and standard treatments or different socioeconomic status and social support for women compared with men.(JAMA. 1994;272:1915-1921)