About AIDS

In the first five years of HIV infection, women have lower amounts of the virus in their blood than men do, but women lose T4/CD4 immune cells and develop AIDS at the same rate as men. The new study points out some considerations in using the HIV treatment guidelines published (and recently revised) by the federal government.

The Johns Hopkins ALIVE cohort, begun in 1988 and the largest long-term work ever done with intravenous drug users, was established to study the natural history of HIV disease among IDUs. Through regular blood testing, they evaluated the risk of progression to AIDS by measuring several factors, including the amount of virus in the blood, known as viral load (VL). Among those who did develop AIDS, the median early viral load of the women was about one-fifth that of the men. However, that initial difference eventually disappeared, and they progressed to AIDS itself at the same speed.

Treatment decisions may be affected because the "when do I start" question is answered partially by viral load and partially by T4/CD4 counts. Among men, therapies should be initiated if VL reaches 55,000 viruses per ml of blood, even with good T4/CD4 counts. However, these new data suggest this indicator shouldn't be used with women. Better to rely on the T4/CD4 count: Men and women alike should start treatment if it falls to 350.

For details, see the March 8 New England Journal of Medicine.