Worldwide, the rate of new HIV infections continues to increase among women. Over the past 5 years there has been a growing focus on the clinical aspects of HIV infection among women. Historically, the majority of subjects enrolled in HIV clinical trials were male patients. Consequently, most knowledge about antiretroviral efficacy and toxicity has been derived from studies of predominately male subjects. More recently, results from clinical trials, especially those that have focused on HIV-infected female subjects, suggest that there may be clinically important gender-related differences in several aspects of HIV disease. These include, but are not limited to, differences in natural history, efficacy and safety of drug treatment. This chapter reviews current data on gender differences in antiretroviral pharmacokinetics and toxicity.

The absence of major sex differences provides reassurance, but the small number of women in these trials limited the ability to draw conclusions. Future trials should be specifically powered to detect sex differences in safety and efficacy.

The availability of potent combination antiretroviral therapy has changed the long-term prognosis for people living with HIV/AIDS. There is increasing concern, however, about the effect of HIV therapy on lipid disorders and subsequent development of coronary artery disease. Virtually all classes of antiretroviral drugs have been associated with some aspect of atherogenic changes in the lipid profiles. This article reviews the current literature on HIV-associated dyslipidemias and the metabolic syndrome, their potential effect on future coronary heart disease, and reviews strategies for management.

In the early years of the HIV epidemic, the burden of the disease was principally among men. In recent years, HIV infection among women has become a growing problem worldwide. There is now an increasing awareness that HIV may affect men and women differently. New data have emerged from studies that have focused on HIV-infected women, suggesting the existence of sex-related differences in natural history, pharmacokinetics, and toxicity of antiretroviral therapy. This paper reviews the current literature with an emphasis on recent data regarding sex differences in HIV that have implications for clinical practice.