Mocroft A, Gill M J, Davidson W, Phillips A N
Royal Free Centre for HIV Medicine, Departments of Primary Care and Population Sciences, Royal Free and University College Medical School, London, UK.
J Acquir Immune Defic Syndr. 2000 Aug 15;24(5):475-82. doi: 10.1097/00126334-200008150-00013.
To describe gender differences in starting and response to treatment regimens and long-term clinical outcome in a well-characterized regional population from the Southern Alberta HIV Clinic (SAC) of 1403 patients, where all medical care for HIV, including physician fees, laboratory tests, and antiretroviral drug costs is provided free of charge.
Observational cohort study.
Cox proportional hazards models were used to examine the relative risk of starting treatment regimens and disease progression (new AIDS-defining illness or death).
There are 126 women in the SAC (9.0%). The median CD4 lymphocyte count at first visit among all patients was 350 cells/mm3, and was significantly higher among women than men (428 cells/mm3 versus 345 cells/mm3, respectively; p = 0.0024). Participating women were less well educated than participating men; 29% of women did not proceed beyond a tenth grade education compared with 13% of men; only 28% of women went to college or received a degree in contrast to 40% of men (p <. 001). The proportion of women in the cohort has increased over the past 5 years (p <.001). During a median follow-up period of 35 months that dates back as far as 1985, 572 patients (40.8%) died or progressed to a new AIDS-defining illness, of whom 30 were women (5. 2%). In a multivariate Cox model stratified by calendar quartile of first visit and adjusted for latest CD4, AIDS status, age, exposure group, education, and prior treatment, women were significantly less likely to start highly active antiretroviral therapy (HAART; defined as at least three antiretrovirals taken consecutively; relative hazard [RH], 0.69; 95% confidence interval [CI], 0.49-0.98; p =.033), significantly less likely to start a protease inhibitor containing treatment regimen (RH, 0.71; 95% CI, 0.52-0.98; p =.040) and significantly less likely to start a HAART regimen including a protease inhibitor (RH, 0.69; 95% CI, 0.48-1.00; p =.049). After adjustment for potentially confounding variables such as CD4 lymphocyte count and treatment regimen, no difference in disease progression was found between men and women (RH, 0.77; 95% CI, 0. 49-1.19; p =.24). Among patients who started HAART, the CD4 lymphocyte count and viral load at starting treatment regimens was similar between men and women, as were the immunologic and virologic response following initiation of treatment.
Despite free access to antiretrovirals, women in the SAC were significantly less likely to start HAART treatment regimens, and the reasons for this need further investigation. Response to treatment was similar between genders. No evidence was found for a poorer long-term clinical outcome in women, but given the proven large clinical benefits of HAART, this may change in the future.
描述来自艾伯塔省南部艾滋病诊所（SAC）的1403例特征明确的区域人群在开始治疗方案、对治疗方案的反应以及长期临床结局方面的性别差异，该诊所为艾滋病患者提供包括医师诊疗费、实验室检查及抗逆转录病毒药物费用在内的所有医疗服务，均免费。
观察性队列研究。
采用Cox比例风险模型来检验开始治疗方案和疾病进展（新发艾滋病定义疾病或死亡）的相对风险。
SAC中有126名女性（占9.0%）。所有患者首次就诊时CD4淋巴细胞计数的中位数为350个细胞/mm³，女性显著高于男性（分别为428个细胞/mm³和345个细胞/mm³；p = 0.0024）。参与研究的女性受教育程度低于男性；29%的女性未接受过十年级以上教育，而男性为13%；只有28%的女性上过大学或获得学位，相比之下男性为40%（p < 0.001）。队列中女性比例在过去5年有所增加（p < 0.001）。在始于1985年的35个月的中位随访期内，572例患者（40.8%）死亡或进展为新发艾滋病定义疾病，其中30例为女性（5.2%）。在按首次就诊的日历四分位数分层并针对最新CD4、艾滋病状态、年龄、暴露组、教育程度和既往治疗进行调整的多变量Cox模型中，女性开始高效抗逆转录病毒治疗（HAART；定义为连续服用至少三种抗逆转录病毒药物；相对风险[RH]，0.69；95%置信区间[CI]，0.49 - 0.98；p = 0.033）的可能性显著降低，开始含蛋白酶抑制剂治疗方案的可能性显著降低（RH，0.71；95% CI，0.52 - 0.98；p = 0.040），开始含蛋白酶抑制剂的HAART方案的可能性也显著降低（RH，0.69；95% CI，0.48 - 1.00；p = 0.049）。在对CD4淋巴细胞计数和治疗方案等潜在混杂变量进行调整后，未发现男性和女性在疾病进展方面存在差异（RH，0.77；95% CI，0.49 - 1.19；p = 0.24）。在开始HAART治疗的患者中，开始治疗方案时的CD4淋巴细胞计数和病毒载量在男性和女性之间相似，治疗开始后的免疫和病毒学反应也相似。
尽管可免费获得抗逆转录病毒药物，但SAC中的女性开始HAART治疗方案的可能性显著降低，其原因需要进一步研究。不同性别对治疗的反应相似。未发现女性长期临床结局较差的证据，但鉴于HAART已证实的巨大临床益处，这一情况未来可能会改变。
