Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection
Sex, Race, and Geographic Region Influence Clinical Outcomes Following Primary HIV-1 Infection
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DOI：
10.1093/infdis/jiq085
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发表时间：
2011-02-15
影响因子：
6.4
通讯作者：
Connick, Elizabeth
中科院分区：
文献类型：
--
作者：
Meditz, Amie L.;MaWhinney, Samantha;Connick, Elizabeth
背景目前尚不清楚性别和种族是否会影响原发性人类免疫缺陷病毒1型（HIV-1）感染后的临床结局。数据来自一个观察性的、多中心的、主要是北美的HIV-1血清转换者队列。在2 277名血清转换者中，5.4%为妇女。在登记时，女性HIV-1 RNA拷贝数平均比男性少0.40 log（10）（P <0.001），CD 4（+）T细胞/μ L平均比男性多66（P = 0.006），年龄和种族控制。与白色男性相比，非白色女性和男性在任何时间点启动抗逆转录病毒治疗（ART）的可能性都较小（P < .005），而来自美国南部的个体与其他人相比（P = .047）。6个月后，性别和种族对ART的反应没有影响（P > 0.73）。女性经历> 1次艾滋病毒/艾滋病相关事件的可能性是男性的2.17倍（P < .001）。非白人女性最有可能经历艾滋病毒/艾滋病相关事件相比，所有其他人（P = 0.035），在调整静脉吸毒和ART后。诊断后8年，来自美国南部的78%的非白人和37%的白人发生了> 1起HIV/AIDS相关事件，白人和其他地区的非白人分别为24%和17%（P <0.001）。尽管最初的临床参数更有利，但女性HIV-1血清转换者的结局比男性血清转换者更差。发病率升高与非白人和居住在美国南部有关。
Background. It is unknown whether sex and race influence clinical outcomes following primary human immunodeficiency virus type 1 (HIV-1) infection.Methods. Data were evaluated from an observational, multicenter, primarily North American cohort of HIV-1 seroconverters.Results. Of 2277 seroconverters, 5.4% were women. At enrollment, women averaged .40 log(10) fewer copies/mL of HIV-1 RNA (P < .001) and 66 more CD4(+) T cells/mu L (P = .006) than men, controlling for age and race. Antiretroviral therapy (ART) was less likely to be initiated at any time point by nonwhite women and men compared to white men (P < .005), and by individuals from the southern United States compared to others (P = .047). Sex and race did not affect responses to ART after 6 months (P > .73). Women were 2.17-fold more likely than men to experience > 1 HIV/AIDS-related event (P < .001). Nonwhite women were most likely to experience an HIV/AIDS-related event compared to all others (P = .035), after adjusting for intravenous drug use and ART. Eight years after diagnosis, > 1 HIV/AIDS-related event had occurred in 78% of nonwhites and 37% of whites from the southern United States, and 24% of whites and 17% of nonwhites from other regions (P < .001).Conclusions. Despite more favorable clinical parameters initially, female HIV-1-seroconverters had worse outcomes than did male seroconverters. Elevated morbidity was associated with being nonwhite and residing in the southern United States.