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Differences Between Women and Men in Adverse Events and CD4+ Responses to Nucleoside Analogue Therapy for HIV Infection

Currier Judith S.; Spino, Cathie; Grimes, Janet; Wofsy, Constance B.; Katzenstein, David A.; Hughes, Michael D.; Hammer, Scott M.; Cotton, Deborah J.; the AIDS Clinical Trials Group 175 Team
JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2000

Objective:To prospectively examine differences in baseline characteristics and study outcomes between HIV-infected women and men during a clinical trial of nucleoside analogue therapy.

Methods:ACTG 175 randomized HIV-infected patients with CD4+ counts between 200 and 500 cells/mm3 to one of four nucleoside analogue regimens: zidovudine (ZDV), didanosine (ddl), ZDV + ddI, or ZDV + zalcitabine (ddC). Differences in time to first dose modification, voluntary withdrawal, development of toxicity and symptomatology, and AIDS progression were compared by gender.

Results:The study included 438 women and 2029 men. Baseline values of HIV RNA plasma concentrations were significantly lower for women (0.3 log10) than men in a subset of patients in whom assays were taken and this difference persisted after adjustment for CD4+ count. Women reported reducing dosage and discontinue ddI-containing regimens more frequently than men did; adjustment for weight did not completely explain this difference. Women were at lower risk than men for progression to a study endpoint (19% of women versus 24% of men; p < .0001). Among those antiretroviral-naive study subjects receiving ZDV, men were four times more likely to progress to a study endpoint than women.

Conclusions:Differences in pretreatment characteristics and on study experiences were demonstrated between women and men enrolled in this clinical trial. The suggestion of a gender difference in response to ZDV monotherapy by antiretroviral-naive study subjects and the lower baseline values for HIV RNA in women compared with those in men provides evidence for gender differences in the relationship between virus replication, CD4+ decline, and responses to nucleoside analogue therapy.

Address correspondence and reprint requests to Judith S. Currier, Center for Clinical AIDS Research and Education, University of California Los Angeles, 10833 Le Conte Avenue, Room #BH-412-CHS, Los Angeles, CA 90095, U.S.A.; email:

C. B. Wofsy is deceased.

Manuscript received February 7, 2000; accepted April 3, 2000.

© 2000 Lippincott Williams & Wilkins, Inc.