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.
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1. Anastos K, Gange SJ, Lau B, Weiser B, Detels R, Giorgi JV et al. Association of race and gender with HIV-1 RNA levels and immunologic progression. J Acquir Immune Defic Syndr 2000; (24):218-26.
2. Rezza G, Lepri AC, d’Arminio Monforte A, Pezzotti P, Castelli F, Dianzani F et al. Plasma viral load concentrations in women and men from different exposure categories and with known duration of HIV infection. ICONA Study Group. J Acquir Immune Defic Syndr 2000; (25):56-62.
3. Kalish LA, Collier AC, Flanigan TP, Kumar PN. Plasma human immunodeficiency virus (HIV) type 1 RNA load in men and women with advanced HIV-1 disease. J Infect Dis 2000; (182):603-6.
4. Moroni M. Sex differences in HIV-1 viral load and progression to AIDS: ICONA Study Group. Italian cohort of HIV-1 positive individuals [letter; comment]. Lancet 1999; (353):589-90.
5. Moore R, Cheever L, Keruly J, Chaisson R. Lack of sex difference in CD4 to HIV-1 RNA viral load ratio. Lancet 1999; (353):463-4.
6. Junghans C, Ledergerber B, Chan P, Weber R, Egger M. Sex differences in HIV-1 viral load and progression to AIDS. Lancet 1999; (353):589.
7. Lyles C, Dorrucci M, Vlahov D, Pezzotti P, Angarano G, Sinicco A et al. Longitudinal human immunodeficiency virus type 1 load in the Italian Seroconversion Study: correlates and temporal trends of virus load. J Infect Dis 1999; (180): 1018-24.
8. Sterling T, Lyles C, Vlahov D, Astemborski J, Margolick J, Quinn T.Sex differences in longitudinal human immunodeficiency virus type 1 RNA levels among seroconverters. J Infect Dis 1999; (180):666-72.
9. Evans JS, Nims T, Cooley J, Bradley W, Jagodzinski L, Zhou S et al. Serum levels of virus burden in earlystage human immunodeficiency virus type 1 disease in women. J Infect Dis 1997; (175):795-800.
10. Sterling TR, Vlahov D, Astemborski J, Hoover DR, Margolick JB, Quinn TC. Initial plasma HIV-1 RNA levels and progression to AIDS in women and men. N Engl J Med 2001; (344):720-5.
11. Fish EN. The X-files in immunity: sex-based differences predispose immune responses. Nat Rev Immunol 2008; (8):737-744.
12. Bouman A, Heineman MJ, Faas MM. Sex hormones and the immune response in humans. Hum Reprod Update 2005; (11):411-423.
13. Ruel TD, Zanoni BC, Ssewanyana I, Cao H, Havlir DV, Kamya M, et al. Sex differences in HIV RNA level and CD4 cell percentage during childhood. Clin. Infect. Dis. 2011 Sep;53(6):592-9.
14. CNLAS. Comisia Nationala de Lupta Anti Sida. Report on HIV/AIDS infection at the 1st December 2012.http://www.cnlas.ro/date-statistice/ (accesed at 4th April 2013)
15. Foca M, Moye J, Chu C, Matthews Y, Rich K, Handelsman E et al. Gender differences in lymphocyte populations, plasma HIV RNA levels, and disease progression in a cohort of children born to women infected with HIV. Pediatrics 2006; (118):146-155.
16. European Collaborative Study. Are there gender and race differences in cellular immunity patterns over age in infected and uninfected children born to HIV-infected women? J Acquir Immune Defic Syndr 2003; (33):635-641.
17. Antiretroviral Therapy for HIV Infection in Infants and Children: towards universal access. Recommendations for a public health approach, WHO Library Cataloguing, Austria, 2010, WHO, Chapter 11. First-line regimen treatment failure; When to switch regimens - Principles, 50.