Melnick S L, Sherer R, Louis T A, Hillman D, Rodriguez E M, Lackman C, Capps L, Brown L S, Carlyn M, Korvick J A
Epidemiology Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892-7620.
JAMA. 1994 Dec 28;272(24):1915-21.
To compare disease progression and mortality between women and men infected with human immunodeficiency virus (HIV).
Multicenter cohort.
Seventeen community-based centers participating in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA).
A total of 768 women and 3779 men enrolled in one or more of 11 protocols between September 7, 1990, and September 30, 1993.
Survival and opportunistic events.
The median CD4+ cell count at enrollment into the cohort was 0.240 x 10(9)/L (240/microL) for women and 0.137 x 10(9)/L for men (P < .001). Compared with men, women were younger (36 vs 38 years), more likely to be African American or Hispanic (78% vs 44%), and more likely to have reported a history of injection drug use (49% vs 27%). Women had been followed up for a median of 14.5 months and men for 15.5 months. The adjusted 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 disease progression (including death) was 0.97 (95% CI, 0.82 to 1.15; P = .72). Women were at increased risk for bacterial pneumonia (RR, 1.38; 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 (RR, 0.54; 95% CI, 0.31 to 0.94). The increased risk of death and bacterial 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 progression at entry, death was the first event reported for more women than men (27.5% vs 12.2%).
Compared with men, HIV-infected women in the CPCRA were at increased risk of death but not disease progression. Risks of most incident opportunistic diseases were similar for women and men; however, women were at an increased risk of bacterial pneumonia. These findings may reflect differential access to health care and standard treatments or different socioeconomic status and social support for women compared with men.
比较感染人类免疫缺陷病毒（HIV）的女性和男性之间的疾病进展及死亡率。
多中心队列研究。
17个参与特里·贝恩艾滋病临床研究社区项目（CPCRA）的社区中心。
1990年9月7日至1993年9月30日期间，共有768名女性和3779名男性参与了11项研究方案中的一项或多项。
生存率和机会性感染事件。
入组队列时，女性的CD4 +细胞计数中位数为0.240×10⁹/L（240/μL），男性为0.137×10⁹/L（P <.001）。与男性相比，女性更年轻（36岁对38岁），更有可能是非裔美国人或西班牙裔（78%对44%），且更有可能有注射吸毒史（49%对27%）。女性的中位随访时间为14.5个月，男性为15.5个月。与男性相比，女性死亡的校正相对风险（RR）为1.33（95%置信区间[CI]，1.06至1.67；P =.01），疾病进展（包括死亡）的RR为0.97（95%CI，0.82至1.15；P =.72）。女性患细菌性肺炎的风险增加（RR，1.38；95%CI，1.05至1.92），患卡波西肉瘤（RR，0.16；95%CI，0.04至0.65）和口腔毛状白斑（RR，0.54；95%CI，0.31至0.94）的风险降低。与男性相比，女性死亡和患细菌性肺炎风险增加主要在有注射吸毒史的人群中明显（死亡RR，1.68，95%CI，1.20至2.35，P =.003；细菌性肺炎RR，1.53，95%CI，1.03至2.29，P =.04）。在入组时无疾病进展史的患者中，报告死亡为首个事件的女性多于男性（27.5%对12.2%）。
与男性相比，CPCRA中感染HIV的女性死亡风险增加，但疾病进展风险未增加。大多数新发机会性疾病的风险在女性和男性中相似；然而，女性患细菌性肺炎的风险增加。这些发现可能反映了女性与男性在获得医疗保健和标准治疗方面的差异，或不同的社会经济地位及社会支持。
