Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection

Amie L. Meditz, Samantha MaWhinney, Amanda Allshouse, William Feser, Martin Markowitz, Susan Little, Richard Hecht, Eric S. Daar, Ann C. Collier, Joseph Margolick, J. Michael Kilby, Jean Pierre Routy, Brian Conway, John Kaldor, Jay Levy, Robert Schooley, David A. Cooper, Marcus Altfeld, Douglas Richman, Elizabeth Connick

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Abstract

Background. It is unknown whether sex and race influence clinical outcomes following primary human immunodeficiency virus type 1 (HIV-1) infection. Methods. Data were evaluated from an observational, multicenter, primarily North American cohort of HIV-1 seroconverters. Results. Of 2277 seroconverters, 5.4% were women. At enrollment, women averaged .40 log10 fewer copies/mL of HIV-1 RNA (P < .001) and 66 more CD4+ T cells/lL (P = .006) than men, controlling for age and race. Antiretroviral therapy (ART) was less likely to be initiated at any time point by nonwhite women and men compared to white men (P < .005), and by individuals from the southern United States compared to others (P = .047). Sex and race did not affect responses to ART after 6 months (P > .73). Women were 2.17-fold more likely than men to experience >1 HIV/AIDS-related event (P < .001). Nonwhite women were most likely to experience an HIV/AIDS-related event compared to all others (P = .035), after adjusting for intravenous drug use and ART. Eight years after diagnosis, >1 HIV/AIDS-related event had occurred in 78% of nonwhites and 37% of whites from the southern United States, and 24% of whites and 17% of nonwhites from other regions (P < .001). Conclusions. Despite more favorable clinical parameters initially, female HIV-1-seroconverters had worse outcomes than did male seroconverters. Elevated morbidity was associated with being nonwhite and residing in the southern United States.

Original languageEnglish (US)
Pages (from-to)442-451
Number of pages10
JournalJournal of Infectious Diseases
Volume203
Issue number4
DOIs
StatePublished - Feb 15 2011

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ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

Cite this

Meditz, A. L., MaWhinney, S., Allshouse, A., Feser, W., Markowitz, M., Little, S., Hecht, R., Daar, E. S., Collier, A. C., Margolick, J., Kilby, J. M., Routy, J. P., Conway, B., Kaldor, J., Levy, J., Schooley, R., Cooper, D. A., Altfeld, M., Richman, D., & Connick, E. (2011). Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection. Journal of Infectious Diseases, 203(4), 442-451. https://doi.org/10.1093/infdis/jiq085