Does Patient Gender Affect CD4+T-lymphocyte Decline and Progression in Human Immunodeficiency Virus to Acquired Immune Deficiency Syndrome

سال انتشار: 1398
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 307

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شناسه ملی سند علمی:

ICCM13_028

تاریخ نمایه سازی: 25 آبان 1398

چکیده مقاله:

Background and Objectives: CD4+T-lymphocyte counts are used to assess the stage of human immunodeficiency virus (HIV) progression and initiation of antiretroviral treatments. Clinical observation suggests HIV-infected women have more rapid progression to acquired immunodeficiency syndrome (AIDS) than men. Matrials and Methods: 5000 HIV-infected cohort population comprising 1,422 (1,111 men, 311 women) HIV-infected patients who attended the Western New York HIV/AIDS, Referral Center at Erie County Medical Center over a 10-year period were recruited. Based upon the inclusion criteria 178 HIV-infected subjects (118 males, 60 females) with CD4+T-lymphocyte counts> 500/μƖ remained for evaluation. Cox’s proportional Hazard-Model was applied for analytical implementation. Results: Results revealed that females had higher mode (600 vs 540) and mean (741.9 vs 712.2) CD4+ counts than males at baseline. However, in contrast to initial higher CD4+ counts, CD4+ decline was faster among females in a shorter time period than males (234.5 vs 158.6, P<0.004), leading to a more rapid HIV progression in females. Univariate proportional-hazard models demonstrated that females had a 40% higher risk for CD4+ decline than males in this study. The bivariate proportional-hazard models rapid CD4+ decline remained greater in females than males. Multivariate analyses which employed Cox’s proportional Hazard-Model to adjust for numerous variables simultaneously suggested that women had almost twice the risk for CD4+ decline and rapid progression to AIDS than males (RR=1.93; 95% CI:1.245, 2.993), with a similar length of time to HIV progression. This finding is supported by many other studies and clinicians experience that enumerations of CD4+T-lymphocytes remain the best immunological steady-state marker of HIV progression and prognosis. Since in this study the risk of CD4+ decline and disease progression in women was approximately two-folds higher than in men, and recent results by other researchers parallel this finding, considerations of changes in therapy protocols may need to be made to account for gender differences. Conclusion: Although the biological mechanism remains unknown, these data suggest there are gender differences in CD4+ decline, with a higher risk of rapid HIV progression in females. Therefore, a major finding of this study was that female life expectancy was half, compared to males. These findings were assured by clinical, laboratory, technical and high performance of QA-QC at different levels of diagnostic lab analyses. Data collection important for CD4+ count confirmed accuracy, reliability and validity of this study. Hence, findings of this study may have important clinical implications and epidemiologic significance.

نویسندگان

Nader Parsa

Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Pari Mahlagha Zaheri

Shiraz University of Medical Sciences, Shiraz, IR Iran.

Lisa Wallin

Strong Memorial Hospital, University of Rochester, Rochester, New York, USA.

Ross G Hewitt

HIV Medical Director, MetroPlus Health Plan, Family Medicine & Community Health the Mount Sinai Hospital.