Treating Women with HIV: Is it Different than Treating Men?

Abstract

While antiretroviral therapy (ART) has had a tremendous impact on the morbidity and mortality of patients with HIV, there is evidence that many HIV-infected women experience treatment challenges that are different from men and these challenges are often associated with poorer outcomes. In the United States, blacks and Latino women are disproportionately affected by the HIV epidemic related to lack of access to high-quality HIV care, and socioeconomic factors. In Africa and Asia, HIV infection in women is affected by gender norms that often leave women dependent upon men (either emotionally or financially) and vulnerable in relationships. These gender norms and, in some cases, fears of violence make it difficult for women to refuse unprotected sex, and can contribute to higher infection rates in women and delayed entry to care. Many African migrants in Europe and Australia may feel stigmatized and fear discrimination when accessing care. As a consequence, despite the availability of highly active antiretroviral therapy, women with HIV often have delayed entry into care and experience poor outcomes. With the notable exception of treatment during pregnancy, there is little in the published literature to suggest that the treatment of choice for treatment-naïve patients should be determined by the patient's sex. While virologic efficacy of ART may be similar in large clinical trials, differences in the frequency of treatment-related side effects and the impact of pregnancy and/or child-bearing status on treatment choice is well documented. In this paper we aim to discuss antiretroviral therapy in HIV-infected women, the sex-specific barriers to starting care, the differences in outcomes, and complications.

Barriers to access to antiretroviral treatment for HIV-positive tuberculosis patients in Windhoek, Namibia

“…The identification of gender-specific challenges for women and for men is in line with research from other countries [33,34]. Healthcare workers should be trained to carefully take gender-related aspects into account in counseling and clinical care of TB/HIV patients.…”

Clinical and Immunologic Outcomes of HAART-Treated HIV-Infected Women in Resource Constrain Settings: The Belgrade Study

“…While the number of studies of the efficacy of HAART have been underpowered for the detection of sex differences, the aggregate data suggest that the men and women experience comparable responses to HAART in terms of CD4+ T-cells gain, rates of virologic suppression, and gains in survival. In 2012, Aziz and collaborators have shown sex differences often featured male and female groups with significant differences in timing of treatment initiation, adherence, concurrent conditions, and drug use (Aziz & Smith, 2012). In 2006, the Global Fund reported that Serbia had one of the lowest HIV testing rates, resulting in high percentage of persons diagnosed at a late stage of the disease (the joint United Nations Programme on HIV and AIDS; UNAIDS, 2006).…”

“…When HAART first became available, women were less likely to be placed on therapy and were observed to have diminished therapeutic outcomes (Furler et al, 2006;Gandhi et al, 2002;Gebo et al, 2000;Gebo et al, 2001). Although more recent data suggest that these gaps have diminished in magnitude, concerns related to decreased access and quality of care for females still persist (Aziz & Smith, 2012;Collazos, Asensi, & Carton, 2007).…”

HIV Providers' Perceptions of and Attitudes Toward Female Versus Male Patients

“…Health literacy was measured using the REALM test (score 0 to 60) with a higher score indicating a higher level of health literacy. Patient clinical variables were CD4 cell count ( £ 200 cells/mm 3 versus > 200 cells/mm 3 ), HIV RNA viral load ( £ 75 copies per milliliter versus > 75 copies per milliliter), receipt of antiretroviral medications, antiretroviral adherence in the last 3 days (100% versus < 100%), active substance and/or alcohol abuse, and presence of at least one comorbid medical condition. Degree of depressive symptoms was measured using the CES-D10 score (0 to 30), with a higher score indicating more depressive symptoms.…”

“…HIV-infected women account for about one quarter of persons living with HIV and have a unique set of health needs. [1][2][3][4][5] HIV-infected women are disproportionately African American and affected by poverty and its attendant consequences such as limited access to quality medical care. 1,2 Accumulating evidence has highlighted gender disparities in the receipt and quality of HIV care.…”