Gender Difference in 2-Year Mortality and Immunological Response to ART in an HIV-Infected Chinese Population, 2006–2008

Since it was initiated in 2002, the China Free Antiretroviral Treatment (ART) Program has been progressing from an emergency response to a standardized treatment and care system. As of December 31, 2009, a total of 81,880 patients in 31 provinces, autonomous regions, and special municipalities received free ART. Gender differences, however, in mortality and immunological response to ART in this cohort have never been described.To understand whether women and men who enrolled in the China National Free ART Program responded equally well to the treatment.A retrospective analysis of the national free ART databases from June 2006-December 2008 was performed. HIV-infected subjects who were 18 years or older, ART naïve at baseline, and on a 3TC regimen enrolled in the program from June 1 to December 31, 2006, were included in this study, then followed up to 2 years.Among 3457 enrolled subjects who met the inclusion criteria, 59.2% were male and 40.8% female. The majority of the subjects were 19-44 years old (77%) and married (72%). Over the full 24 months of follow-up, the mortality rate was 19.0% in males and 11.4% in females (p = 0.0014). Males on therapy for 3-24 months were more likely to die than females (HR = 1.46, 95% CI: 1.04-2.06, p = 0.0307) after adjusting for baseline characteristics. Compared to men, women had higher CD4+ counts over time after initiating ART (p<0.0001).Our study showed that women had an overall lower mortality and higher CD4+ counts than men in response to ART treatment, which may be attributed to adherence, biological factors, social, cultural and economic reasons. Further study is needed to explore these factors that might contribute to the gender differences in mortality and immunological response to ART

Peripheral Blood Lymphocyte Subsets in Adolescents: a Longitudinal Analysis from the REACH Project

Flow cytometry analysis of lymphocyte subset markers was performed for a group of sexually active, human immunodeficiency virus (HIV)-negative adolescents over a 2-year period to establish normative data. Data were collected in the REACH Project (Reaching for Excellence in Adolescent Care and Health), a multicenter, longitudinal study of HIV-positive and high-risk HIV-negative adolescents. Two- and three-color flow cytometry data were collected every 6 months for these subjects. We determined the effects of gender, race, and age on the following lymphocyte subset markers: total CD4(+) cells, CD4(+) naïve cells, CD4(+) memory cells, all CD8(+) cells, CD8(+) naïve cells, CD8(+) memory cells, CD16(+) natural killer cells, and CD19(+) B cells. Gender was the demographic characteristic most frequently associated with differences in lymphocyte subset measures. Females had higher total CD4(+) cell and CD4(+) memory cells counts and lower CD16(+) cell counts than males. Age was associated with higher CD4(+) memory cell counts as well as higher CD8(+) memory cell counts. For CD19(+) cells, there was an interaction between age and gender, with males having significantly lower CD19(+) cell counts with increasing age, whereas there was no age effect for females. Race and/or ethnicity was associated with differences in total CD8(+) cell counts and CD8(+) memory cell counts, although both of these associations involved an interaction with gender

Prophylactic Intravenous Immunoglobulin in HIV-Infected Children With CD4+ Counts of 0.20×109/L or More: Effect on Viral, Opportunistic, and Bacterial Infections

Objective.—To evaluate the efficacy of intravenous immunoglobulin (IVIG) for prevention of viral, opportunistic, and minor bacterial infections in children infected with human immunodeficiency virus (HIV).Design.—Randomized, double-blind, placebo-controlled, outpatient clinical trial comparing subjects treated with 400 mg of IVIG per kilogram of body weight every 28 days with those given albumin placebo.Setting.—Twenty-eight clinical centers in mainland United States and Puerto Rico.Patients.—Three hundred seventy-six children infected with human immunodeficiency virus with clinical or immunologic evidence of HIV disease, 313 of whom had entry CD4+ counts of at least 0.20×109/L (≥200/mm3).Main Outcome Measures.—The incidence of laboratory-proven and clinically diagnosed viral, opportunistic, and bacterial infections.Main Results.—Viral infections and minor bacterial infections contributed more frequently to morbidity in children with entry CD4+ counts of at least 0.20×109/L (together over five times as frequent) than did serious bacterial infection, the primary outcome measure of the trial. Opportunistic infections occurred at a similar rate as laboratory-proven serious bacterial infections. In this group of children, IVIG was significantly associated with a decrease in the rate of viral infections and minor bacterial infections per 100 patient-years (36.0 vs 54.0 episodes of viral infection per 100 patient-years, IVIG vs placebo,P=.01; and 115.1 vs 159.7 episodes of minor bacterial infection per 100 patient-years, IVIG vs placebo,P-.02), as well as a decrease in the rate of serious bacterial infections per 100 patient-years (26.4 vs 48.2 episodes per 100 patient-years;P=.002). There was no apparent difference in the rate of opportunistic infections between treatment arms.Conclusions.—Beneficial effect of IVIG was seen across multiple infectious outcome measures, with reductions in serious and minor viral and bacterial infections observed in children with entry CD4+ counts of at least 0.20×109/L.(JAMA. 1992;268:483-488