Study: Sex, race and location may influence HIV outcomes

Women in the United States suffer from HIV-related illnesses more than twice as much as men according to a new study in The Journal of Infectious Diseases. The study also found minorities and people living in the South shoulder a much higher burden of HIV/AIDS related disease than anyone else in the country. Minority women have worse outcomes, according to the study.

During a ten-year period starting in 1997, researchers followed more than 2,000 patients within a year of diagnosis. Patients were tracked an average of four years. Researchers say they were surprised to find that women had the worst outcomes even though after diagnosis they had lower viral loads and higher CD4+ T cell counts than the men.
Viral load is the concentration of the virus in the blood. T cells help the immune system in fight infections.

Most of the men in the study were white, the majority of women were minorities. Half of these women were from the South. The study found 64% of minority women had HIV-related illness and 22% suffered from AIDS-related illnesses. By comparison patients from other race and sex groups had 21% HIV-related and 6% AIDS-related events.

78% of non-whites in the South had at least one HIV/AIDS-related illness versus 17% in other regions.

"To me that's just incredible," said Dr. Amie Meditz, University of Colorado-Denver and lead author. "We have to figure out why this group had poor outcomes and we have to develop strategies on how to fix this."

Study investigators also found minorities and patients living in the South were less likely to start antiretroviral therapy than their counterparts elsewhere. Standard antiretroviral therapy uses a combination of antiretroviral drugs to suppress the virus and stop the disease from progressing. But researchers say this may only be part of the reason for these differences. They say socioeconomic factors like access to care, lifestyle and environmental exposures may play a part in this increased rate of infection.

"Despite striking advances in the treatment of HIV-infection, this study points out that there are other factors that are beyond the sphere of science, medicine and the health care system that can substantially impact the health outcome of HIV-infected individuals," said Dr. Anthony Fauci, Director, National Institute of Allergy and Infectious Diseases, who funded the study.

"Paramount among these is the influence of socioeconomic factors that often determine access to health care as well as contribute in a negative way to a lifestyle detrimental to optimal health outcomes in the acquisition and treatment of a number of diseases including HIV infection."

But Phill Wilson, dxecutive director of the Black AIDS Institute, says these disparities have been known for some time. He says the challenge is to determine why and find solutions.

"We need to be doing more studies to get a better understanding why people of color, women in general, men having sex with men in general, and black men having sex with men in particular do not fair as well, what are the core causes," Wilson said.

"We know one problem in the South is we have a high patient to physician ratio. We know a disproportionately high number of doctors in the U.S. are not experienced in treating HIV. We have an inferior health care system in the southeast region of the U.S. that attributes to poor HIV outcomes and we have an elevated level of stigma that delays diagnosis and increases risk."

Meditz says the study proves there's work to be done. "There's still race and sex differences in health care outcomes and there's an urgent need that we have to improve health care as it relates to HIV to make it equal for all groups."