AIDS Shows No Gender Bias, Researchers Report : Disease: U.S. scientists discredit theory that women are quicker to get sick and slower to get treatment.
In a surprising finding, U.S. researchers reported Monday that there appear to be no differences between men and women in how quickly they become sick or die from AIDS, nor are there gaps in the rates at which each receives AIDS-related therapies.
In recent years, some activists and researchers have insisted that women grow sick faster than men and have less access to treatments. In part, the reason for this may be that early in the epidemic, the disease was often diagnosed in women later than men because clinicians were not looking for the signs of AIDS in women. During that time, acquired immune deficiency syndrome was primarily striking gay men.
“These investigations are important, particularly because this is the first large, prospective study to show that men and women share similar consequences of their HIV (human immunodeficiency virus) disease,” said Lawrence R. Deyton, assistant director for community research at the National Institute of Allergy and Infectious Diseases.
The results were presented at the eighth International Conference on AIDS. Nearly 11,000 researchers, activists and others from more than 130 countries are attending the meeting, which is considered the most important forum for the exchange of information about the deadly disease.
In a study of 4,202 men and women, Dr. Renslow Sherer, director of the HIV primary care center at Cook County Hospital in Chicago, found that HIV-infected women and men do not differ significantly in the illnesses they develop or their rates of death.
Investigators collected data on the participants every six months during the last two years. Seventy percent of them were between 30 and 49 years of age. Forty percent were black, 18% Latino and 42% white. Nearly one-fifth of the women and nearly one-third of the men used drugs intravenously, a practice that can spread the virus.
In a second report, Dr. Linnea Capps, assistant clinical professor of medicine at Columbia University and attending physician at Harlem Hospital in New York, found no significant differences based on gender for those receiving antiviral treatment and therapy for pneumocystis carinii pneumonia, a common AIDS-related opportunistic infection.
However, the study showed that people under 35--regardless of their gender--were less likely than older people to receive either treatment. The investigators do not know why this occurs, but they speculated that younger people may seek medical care less frequently or tend to be generally less compliant with medical regimens.
Capps’ 16-month study of 2,850 participants--more than one-quarter of them women--showed no significant gender differences in delivery of care. The participants included 39% blacks, 46% whites and 15% Latinos, and more than half of the women and one-third of the men were intravenous drug users.
Both research projects were sponsored by the Terry Beirn Community Programs for Clinical Research on AIDS, administered under the allergy and infectious diseases institute, which is part of the National Institutes of Health in Bethesda, Md. The reports came on a day when Dr. Michael H. Merson, director of the global program on AIDS for the World Health Organization, reported that this year close to half the 1 million newly infected adults are women and predicted that by the year 2000, women may account for the majority of new infections.
The AIDS meeting is a forum for social and political ideas as well as research results, and a Columbia University psychologist received a rousing response to her critique of attempts to prevent AIDS thus far.
Global efforts to change sexual behavior--and thus contain the spread of AIDS--have been crippled by a battle between public health “realists” and religious “moralizers,” declared Anke A. Ehrhardt, who also directs the New York State Psychiatric Institute’s HIV Center for Clinical and Behavioral Studies. “Programs of re-virginization will not work. This struggle between realists and moralizers has to come to an end.”
In the United States, “it has led to a paralysis of action, to discrimination and homophobia, and will cause HIV infection and death in countless people,” she said in a reference to the Bush Administration’s decision to cancel planned sexual behavior studies after political pressure from conservatives.
Sexual behavior studies must become a priority in order to design effective prevention programs, which should be geared specifically to age, gender and culture, Ehrhardt said.
She said public health advocates simply want to change sexual practices that put people at risk and exclude from that goal judgments as to whether “sex is good or bad.”
“The moralizing position may range from labeling sexual behavior outside of heterosexual marriage as sinful--in which case disease prevention becomes secondary to moral principles--to the extreme position that if the sinner does not change his or her sexual behavior, he or she may be doomed--and deserves to die.”
Meanwhile, steady progress in fighting the disease was reported on the scientific front, although no dramatic breakthroughs are anticipated.
In vaccine research, Dr. Robert Redfield of the Walter Reed Army Institute of Research is expected to report today that an experimental therapeutic vaccine made from the “envelope” that encapsulates the virus resulted in a 95% decrease in the amount of detectable HIV over the course of a year in individuals who were vaccinated.
A therapeutic vaccine is used for treatment in already infected individuals, as opposed to a preventive vaccine, which is given to protect against infection.
Researchers have concluded that the vaccine, manufactured by MicroGeneSys, based in Meriden, Conn., is safe, and they are currently testing it to determine whether it is effective.
Researchers do not yet know whether this decrease in the virus will translate into fewer symptoms, but this has been the case with antiviral drug therapy.
New results were also reported showing early promise for a number of experimental vaccines:
* The first genetically engineered vaccine designed to match the shape of the naturally occurring gp160 envelope protein--the same protein used in Redfield’s trials--stimulates the production of antibodies against HIV and is well-tolerated in adult volunteers, researchers from St. Louis University School of Medicine reported.
“The results . . . are encouraging because the vaccine is safe and the antibody responses are larger than those observed with similarly low doses of other HIV vaccines,” said Dr. Robert Belshe, the lead researcher. It is still unclear whether antibodies produced by the vaccine, Immuno AG, will have a protective effect against the virus.
* Another candidate vaccine made by Genentech Inc. of South San Francisco from a bioengineered form of the viral envelope protein gp120 was well-tolerated by volunteers at two different doses and evoked a variety of immune responses, researchers from the Johns Hopkins Center for Immunization Research reported.
* Results from the longest-running vaccine trial using a combination of two different approaches continues to be favorable, according to researchers at the University of Washington School of Medicine. This approach, called the “prime boost,” combines an immunization based on the vaccinia virus, which was used to protect against smallpox, with booster injections of the MicroGeneSys vaccine.
The third booster vaccination, administered 12 to 20 months after the second, increased overall antibody levels two to five times more than the second shot, according to Dr. Julie McElrath of the University of Washington.
Dr. Barney Graham, director of the Vanderbilt University AIDS vaccine evaluation unit--who reported at last year’s conference that a combination of two vaccines produced a better immunity response than any single vaccine alone--said he believes that the “prime boost” strategy can be further enhanced by lengthening the interval between primer and booster.
In another development, UC San Francisco researchers reported that patients taking the antiviral drug DDI who experienced increases in the key immune system CD4 cells also lived longer and spent more time free of symptoms than patients on the drug who did not have rises in CD4 cells. The finding is important because it underscores the use of so-called “surrogate markers”--early indications of drug efficiency--such as CD4 cell increases, as a basis for approving new drugs. DDI was approved on just such a basis.
