SURVIVAL AND DISEASE PROGRESSION ACCORDING TO GENDER OF PATIENTS WITHHIV-INFECTION - THE TERRY-BEIRN-COMMUNITY-PROGRAMS FOR CLINICAL RESEARCH ON AIDS

Objective.-To compare disease progression and mortality between women and men infected with human immunodeficiency virus (HIV). Design.-Mult icenter cohort. Setting.-Seventeen community-based centers participati ng in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). Patients.-A total of 768 women and 3779 men enrolled in one or more of 11 protocols between September 7, 1990, and September 30, 1 993. Main Outcome Measures.-Survival and opportunistic events. Results .-The median CD4(+) cell count at enrollment into the cohort was 0.240 x10(9)/L (240/mu L) for women and 0.137 x10(9)/L for men (P<.001). Co mpared with men, women were younger (36 vs 38 years), more likely to b e African American or Hispanic (78% vs 44%), and more likely to have r eported a history of injection drug use (49% vs 27%). Women had been f ollowed up fora median of 14.5 months and men for 15.5 months. The adj usted relative risk (RR) for death among women compared with men was 1 .33 (95% confidence interval [CI], 1.06 to 1.67; P=.01) and for diseas e progression (including death) was 0.97 (95% CI, 0.82 to 1.15; P=.72) . Women were at increased risk for bacterial pneumonia (RR, f.38; 95% CI, 1.05 to 1.92) and at reduced risk for the development of Kaposi's sarcoma (RR, 0.16; 95% CI, 0.04 to 0.65) and oral hairy leukoplakia (R R, 0.54; 95% CI, 0.31 to 0.94). The increased risk of death and bacter ial pneumonia for women compared with men was primarily evident among those with a history of injection drug use (RR, 1.68 for death, 95% CI , 1.20 to 2.35, P=.003; RR, 1.53 for bacterial pneumonia, 95% CI, 1.03 to 2.29, P=.04). Among patients without a history of disease progress ion at entry, death was the first event reported for more women than m en (27.5% vs 12.2%). Conclusions.-Compared with men, HIV-infected wome n in the CPCRA were at increased risk of death but not disease progres sion. Risks of most incident opportunistic diseases were similar for w omen and men; however, women were at an increased risk of bacterial pn eumonia. These findings may reflect differential access to health care and standard treatments or different socioeconomic status and social support for women compared with men.