AIDS viral load hits women harder New research suggests females need treatment earlier in infection


Women infected with HIV may be at a more advanced stage of infection and at a higher risk of developing AIDS than men with identical results on certain blood tests, researchers are reporting.

The researchers suggest that treatment guidelines, used for both sexes even though they are based on research involving only men, should be changed to recommend earlier treatment for women. But other researchers say changing treatment guidelines at this point would be premature.

The recommendations are based on a study conducted at the Johns Hopkins School of Public Health, published today in the British medical journal Lancet.

The study's researchers measured virus levels in the bloodstream, or "viral load," a major factor in deciding when patient should begin treatment with anti-viral drugs.

They found that at a given stage of infection, a woman's viral load will be lower than a man's even though her immune system has sustained as much damage.

The researchers do not know why, they said. But they warned that doctors who use the viral load as a benchmark may be misled into thinking the woman is healthier than she really is.

The new study adds fuel to a larger debate among AIDS experts about the best time for people with HIV to begin taking anti-viral drugs.

Combinations of those drugs have led to such stunning drops in the AIDS death rate that many researchers think patients should be treated as soon as possible to suppress the virus and prevent damage to the immune system.

Other doctors, concerned about dangerous side effects of treatment and the ability of HIV to become drug resistant, say they think that patients who are not ill should postpone treatment for as long as possible.

Guidelines issued this year by the U.S. Public Health Service recommend starting treatment in both men and women when the viral load climbs to 10,000 copies of HIV per milliliter of blood. That level is generally taken as a sign that the immune system is losing ground to the virus.

But a viral load of 5,000 in a woman may be just as bad as a reading of 10,000 in a man, according to the study. A woman with half the viral load of a man has the same risk of developing AIDS as that man, and if the two have the same virus level, the woman is more likely to develop AIDS, the Johns Hopkins researchers found.

Their conclusions were based on a study of 650 male and female drug users infected with HIV.

Pub Date: 11/06/98

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