Durban World AIDS Conference
Durban, South Africa
Tuesday, July 11, 2000

Report 11

UAB Women & HIV

Kathleen Squires, USC

I walked in late, and so this report is not complete, but entered when an African women from South Africa was speaking. Her talk was very moving to me and distressing. She said she was ashamed to be South African because of Mbeki's positions. There is a disproportionately high % of women infected with HIV in women in Sub Saharan Africa and in South Africa. I think Squires said it was 55% in South Africa. I disproportionate % is among women 15-24 years in the 15-49 year age group. Black women in the Us in all regions have the highest incidence. About 70% of infected women are Black, Hispanics are second and caucasians are third. Women present themselves often commonly with vaginal candidiasis (37% in study Squires presented). In one natural history study 44% (n=196) of women (n=1200), 24% were taking HAART, many had over 200 CD4s, many who needed PCP prophylaxis were not receiving it. In USA women receive less effective therapy than men--there is a gender difference. There are many reasons why women lack access to treastment--chold care, low education & income, perinatal care, and more. Women need regular gynecologic exams (except if CD4s >200 once yearly), pap smears every 6 months to detect cervical dysplasia, increased VL is asociated with increased risk of abnormal smears. They need reproductive health counselling and routine screening for STDs. Women with HIV have increased incidence of gyno coinfections  and don't respond to treatment for these infections as well as people w/o HIV. 66% of women w/ HIV are coinfected with HPV vs 34% among HIV negative women. 24% vs 4% in 220 HIV infected women vs 231 HIV negative women. Are we going to see increase in HPV because women will live longer due to HAART, or not--open question.

Women need to be included in studies so we can learn more about women and treatment. There are lots of questions and we can't get answers unless women participate in studies.

Judith Currier, UCLA

Global issues for women around the world:

Women are less likely to have PCP prophylaxis, more likely to seek care in emergency rooms. PK and toxicity may be different for women than men. Several studies show that viral load for women is different for women than men. Viral load has been found to be lower in women than men (from 0.3 log to 0.5 log; 40-50% lower in women than in men). But it appears that women don't progress faster than men, when looking at OI development and time to death. Viral load can increase more rapidly over time and converge over time with men's viral load. In sum, there is no evidence that women progress more quickly despite lower viral load earlier in course of disease. What is the explanation, and what does this mean for the Treatment Guidelines. We need answers to these questions. This may mean that women can delay therapy. However, we should monitor women to see if therapy delay is meaningful. This may have affect on entry criteria into studies. One Kenyan study showed women seroconverters had more diverse genetic isolates. What does this mean?

PK

Sex differences in that may affect the way treatment is used:  

Absorption, drug metabolism, hormonal changes, weight

An example is dosing for ddI based on weight. Women may not tolerate ritonavir as well, based on study she showed.

She discussed gender differences in lipodystrophy. Women tend to get breast enlargement, bigger stomach. Men tend more to get lipo-atrophy.  FDA report of reported cases of lactc acidusis. More women than men were reported to have lactic acidosis. Although bone loss has been reported for men on PI there is no study on women who may have bigger concern. This should be studied. We don't know although it appears to be the same, whether women have less virologic response to HAART than men. Toxicities or side effects to HAART may be different for women than men.

Nevirapine, ritonavir and nelfinavir reduce blood levels of oral contraceptives.

Cheryl Holder, physician in Miami.