Women and AIDS -- Unexplained Higher Risk of Death

A study of 768 women and 3779 men with HIV found that the
women had a one-third higher risk of death then the men --
and yet no higher risk of progressing to AIDS -- after
statistical adjustment for stage of illness. The cause of the
difference is unknown.

The study was conducted by the Terry Beirn Community Programs
for Clinical Research on AIDS (CPCRA), through analysis of
the records of volunteers already enrolled in existing CPCRA
studies. In this way, it studied the largest cohort of women
with HIV yet reported. It did find gender differences in
opportunistic infections and conditions (for example, about a
one-third higher risk of bacterial pneumonia in women, and a
much-lower risk of Kaposi's sarcoma, which occurred in only
two women). But these differences could not explain the
overall survival and disease-progression results.

The researchers also found that, "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%)."

The researchers could not offer a definitive reason for
poorer survival of women, but suggested looking at
differences in access to healthcare, and at effects of "lower
socioeconomic status, homelessness, domestic violence,
substance abuse, and lack of social support."

The study was published in JAMA (JOURNAL OF THE AMERICAN
MEDICAL ASSOCIATION), December 28, 1994.

Comment

This important study raises questions it does not answer. Why
do women have an overall increased risk of death, yet no
increased risk of progression to AIDS? And why is death more
often the first AIDS-defining event? These findings suggest
problems with the 1987 definitions of AIDS-indicating events
-- based almost entirely on the disease in men -- but that
was not the conclusion of the study. One difficulty in
interpreting the data is that the cause of death was often
unknown.

Another mystery is that women had a considerably higher T-
helper count at entry -- a median of 240, vs. a median of 137
for the men. This difference was not explained in the
published paper. We would have expected a difference in the
opposite direction, since women often receive worse health
care than men, due to economic reasons, and are often not
diagnosed with HIV until a later stage of the illness.

AIDS in women has increased more than 20 times since 1981; it
is now one of the five leading causes of death among women
aged 25 to 44 nationally, and the leading cause of death in
that age group in New York City.