Abstract
Introduction: Prior studies assessing sex differences correlated with the levels of human immunodeficiency virus (HIV) RNA and absolute CD4 cell count in adults and children, treated or untreated with antiretroviral (ARV) therapy presented conflicting results. Objective: To assess comparative HIV RNA levels and absolute CD4 cell count in men and women from a large cohort of HIV-infected long term survivors patients. Methods: 462 HIV infected patients were analyzed cross-sectionally and longitudinally after being split into three groups: 156 naïve deceased patients, median age at death 10 years, 197 ARV treated patients, median age 17 years and 109 ARV treated patients, median age 23 years followed up until 2011. HIV RNA and absolute CD4 cell count were measured in all patients enrolled in the study. Results: In cross-sectional analysis of 156 naïve patients HIV RNA median levels were lower in females comparing to males, 4.95 vs. 5.73 HIV RNA log10 (copies/ml). Female absolute CD4 cell count was slightly higher, (median 97 vs. 65.5 cells/μL; P = 0.0001). Cross-sectional analysis of 197 ARV treated patients showed a lower log10 HIV RNA level in females compared to males, (P=0.0001), and also lower median CD4 count values in women, 336 cells/μL vs 456 cells/μL in men, P=.0001. Longitudinal analysis revealed statistically significant results: mean log viral loads were lower in females (F=13.90, P= 0.0009) and absolute CD4 cell count was lower in malse (F=16.72, P<0.0001), almost across all tested ages. Conclusion: We report steady sex differences in HIV RNA levels and absolute CD4 cell count in ART-treated HIV-infected patients, a fact that may suggest a reevaluation of our current treatment strategies according to sex.
Rezumat
Introducere. Studiile anterioare care evaluează diferenţele în funcţie de sex ale încărcăturii virale HIV şi ale numărului absolut de celule CD4 la adulţi şi copii trataţi sau netrataţi cu terapie antiretrovirală au prezentat rezultate contradictorii. Obiectiv: Evaluarea comparativă a valorilor incărcăturii virale ARN HIV şi a numărului absolut de celule CD4 la bărbaţi şi femei, într-un lot de pacienţi infectaţi cu HIV, supravieţuitori de lungă durată. Metode: 462 pacienţi infectaţi cu HIV au fost analizaţi prin studii transversale şi longitudinale, după împărţirea în trei grupe: 156 pacienţi netrataţi anterior şi decedaţi, cu vârsta medie la deces 10 ani; 197 pacienţi trataţi cu antiretrovirale, de vârstă medie 17 ani şi 109 pacienţi trataţi cu antiretrovirale, de vârstă medie 23 ani, care au fost monitorizaţi până în anul 2011. Incărcătura virală ARN HIV şi numărul absolut de celule CD4 au fost determinate la toţi pacienţii înrolaţi în studiu. Rezultate: Analiza transversală a celor 156 pacienţi netrataţi anterior a arătat că nivelurile medii ale încărcăturii virale ARN HIV au fost mai mici la femei comparativ cu bărbaţii, 4.95 vs 5.73 log10 copii/ml. Valoarea numărului absolut de celule CD4 a fost mai mare la femei, (valoare mediană: 97 vs 65.5 celule/μL, P = 0.0001). Analiza transversală a celor 197 pacienţi trataţi cu aniretrovirale a arătat o diferenţă de 1 log10 ARN HIV între femei şi bărbaţi, cu un nivel mai scăzut al încărcăturii virale la femei, (P = 0.0001), de asemenea valoarea mediană a numărului de celule CD4 a fost mai scăzută la femei, 336 celule/μL vs 456 celule/μL la bărbaţi, P = 0.0001. Analiza longitudinală a arătat rezultate semnificative statistic: valorile mediane ale încărcăturii virale erau mai scăzute la femei (F = 13.90, P = 0.0009) şi valorile numărului absolut de celule CD4 erau mai scăzute la bărbaţi (F = 16.72, P<.0001), aproape la toate categoriile de vârstă testate. Concluzie: Raportăm diferenţe constante în funcţie de sex, atât pentru nivelurile încărcăturii virale ARN HIV, cât şi pentru valorile numărului absolut de celule CD4, la pacienţii infecţati cu HIV şi trataţi cu terapie antiretrovirală, fapt care ar putea sugera o reevaluare a strategiilor actuale de tratament în funcţie de sex.
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