Comparison of clinical manifestations of HIV infection among women by riskgroup, CD4(+) cell count, and HIV-1 plasma viral load

Objectives: To compare the prevalence of HIV-related symptoms, physical exa mination findings, and hematologic variables among women whose risk for HIV is injection drug use since 1985 as opposed to sexual contact and to evalu ate the influence of HIV plasma viral load and CD4(+) cell count on clinica l manifestations according to risk. Methods: Participants of the HIV Epidemiology Research Study (HERS; a multi center, prospective, controlled study of HIV infection in women) were admin istered a risk behavior and symptom interview, underwent a physical examina tion, and received hematologic testing, including CD4(+) cell counts done o n study entry. Plasma HIV-1 viral loads were performed on stored frozen pla sma using an ultrasensitive branched-DNA (b-DNA) signal amplification assay . CD4(+) counts were categorized as <200 cells/mu l, 200 to 499 cells/mu l, or greater than or equal to 500 cells/mu l, and HIV viral loads were chara cterized in tertiles. Results: Cross-sectional analysis was conducted on data available for 724 H IV-infected women: 387 had a history of intravenous drug use and 337 were i nfected through heterosexual contact. The median CD4(+) count was 376 cells /mu l; the median HIV-1 viral load was 1135 copies/ml; and 281 of 724 HIV-i nfected women (38.8%) had an undetectable HIV-1 viral load. In analyses adj usting for CD4(+) cell level alone and for plasma viral load combined with CD4+ cell level, injection drug users (IDUs) were more likely than those in fected through heterosexual contact to report a recent episode of memory lo ss and weight loss, but less likely to have recent episodes of genital herp es; to have enlarged livers and a body mass index (BMI) <24, and to have he matocrit levels <34% and platelet counts <150,000 cells/ml. After adjustmen t for CD4(+) cell level and risk group high and medium HIV-1 plasma viral l oad levels were associated with the presence of oral hairy leukoplakia on e xamination, and only the highest level of plasma viral load was associated with recent histories of fever and thrush. oral hairy leukoplakia, pseudome mbranous candidiasis, and BMI <24 on examination, and hematocrit <34%. Conclusions: In this cohort of women, the distribution of HIV-1 plasma vira l load was lower than that previously reported in populations of HIV-infect ed men. This study also shows some differences in frequency of signs, sympt oms, and laboratory values between risk groups of HIV-infected women, but t hese results may be due to effects of injection drug use rather than HIV in fection. Signs and symptoms identified as associated with increasing levels of viral load that were not different across risk groups suggest more dire ct association of these findings with HIV infection.