HIV DISEASE PROGRESSION IN 854 WOMEN AND MEN INFECTED THROUGH INJECTING DRUG-USE AND HETEROSEXUAL SEX AND FOLLOWED FOR UP TO 9 YEARS FROM SEROCONVERSION

Objective-To compare the progression of HIV-1 infection in men and wom en followed up for up to nine years after an accurately estimated date of seroconversion. Design-Prospective observational study. Setting-16 HIV outpatient clinics across Italy. Subjects-321 women and 533 men i nfected with HIV through injecting drug use or heterosexual sex and wi th accurately estimated dates of seroconversion. Main outcome measures -Progression to severe CD4 lymphocytopenia (CD4 lymphocyte count < 200 x 10(6)/1), development of AIDS defining diseases, and death from AID S. Results-Thirty two women and 67 men developed AIDS at Kaplan-Meier progression rates of 25% (95% confidence interval 13.8% to 35.5%) and 23% (15.6% to 30.4%), respectively, 7 years after seroconversion. In a Cox proportional hazards model the relative hazard was 0.93 (that is, a slightly lower hazard in women) before and 1.10 (0.70 to 1.72) afte r adjusting for age, HIV exposure group, and year of seroconversion. W hen CD4 lymphocytopenia and death from AIDS were used as end points th e results were similar, with adjusted relative hazards of 0.95 (0.63 t o 1.42) and 0.72 (0.48 to 1.79) respectively. In both women and men th e risk of developing AIDS before the CD4 lymphocyte count had declined below 200 x 10(6)/1 was small (3% in women, 6% in men). The estimated median count at which AIDS developed in women (34 x 10(6)/1; 10 x 10( 6) to 44 x 10(6)) was similar to that for men (44 x 10(6)/1; 22 x 10(6 ) to 60 x 10(6)). Conclusion-There seems to be little evidence for app reciable differences in the natural course of HIV infection between me n and women followed up from the time of seroconversion.