A prospective study of HIV disease progression in female and male drug users

Objective: To compare HIV disease progression and mortality in a cohort of female and male drug users. Design: A prospective cohort study of 222 HIV-seropositive women and 302 HI V-seropositive men who attended a hospital-affiliated methadone maintenance program with on-site primary care. Methods: Regression slopes of CD4+ cell decline were compared using the two sample t-test, and the distribution of AIDS-defining illnesses evaluated b y Mantel-Haenszel chi(2) test. Time to AIDS-defining clinical conditions an d death were compared using the Kaplan-Meier log-rank test. Multivariate es timates of progression to clinical AIDS or death, for all participants, str atified by sex, were derived from Cox proportional hazards models. Results: Ninety-five persons (43 women and 52 men) developed AIDS-defining conditions. Analyses of the rates of CD4+ cell decline, the distribution of first AIDS-defining illnesses, and the time to clinical AIDS did not diffe r by sex. In the multivariate model, sex was not associated with an AIDS ou tcome, whereas crack-cocaine use [hazards ratio (HR), 1.815; 95% confidence interval (CI), 1.151-2.863], CD4+ cell count (100 x 10(6)/l; HR, 0.589; 95 % CI, 0.511-0.679), and two or more HIV-related symptoms (HR 1.702; 95% CI, 1.125-2.576) were associated. Mortality rates (8.71 per 100 person-years i n women and 9.85 per 100 person-years in men) were similar, using univariat e or multivariate methods. Conclusions: There was little difference in clinical outcomes or mortality between HIV-seropositive female and male drug users with access to primary care. However, crack-cocaine use was independently associated with progress ion to clinical AIDS. (C) 1999 Lippincott Williams & Wilkins.