CHICAGO -- Women infected with HIV have a 30 percent higher risk of dying from acquired immune deficiency syndrome than do men over the same time period -- despite the fact that HIV disease progresses at the same rate in both sexes, according to a new study.
In the largest effort yet to focus on women and the human immunodeficiency virus, which causes AIDS, scientists studied 768 HIV-positive women and 3,779 HIV-positive men over a three-year period to look for any differences in the course of disease between the two genders.
The researchers found that the risks of developing most AIDS-related infections were similar for women and men, although women did have an increased risk for bacterial pneumonia and a reduced risk for a cancer called Kaposi's sarcoma.
The immune system, as evidenced by the decrease in disease-fighting white blood cells called CD4 cells, also deteriorated at the same rate in both sexes, the study showed.
The authors of the study, which appears in tomorrow's Journal of the American Medical Association, could not explain the women's higher risk of dying, citing a number of socioeconomic factors as possible causes. These included poor access to health-care resources, homelessness and substance abuse.
Over the past several years, the pattern of HIV infection has changed from primarily affecting men to affecting both genders equally, the authors noted.
However, "current recommendations for medical management of HIV disease are based largely on observations of disease progression among men," according to lead author Sandra Melnick of the University of Minnesota School of Public Health in Minneapolis.
As a step toward amending the situation, researchers studied men and women from 17 different community-based centers between September 1990 and September 1993.
Compared with men, women were slightly younger, more likely to be African-American or Hispanic (78 percent vs. 44 percent) and more likely to have reported a history of injection-drug use (49 percent vs. 27 percent).
The risk for death was strongest among women with a history of injection-drug use, the study showed.
Dr. Thomas Quinn, a senior investigator at the National Institute of Allergy and Infectious Diseases in Bethesda, noted that socioeconomic factors should be addressed. "If they had just controlled for that, I bet the mortality would not have been so different," he said.
Some of the women in the study may not have received drug therapy as quickly as the men, he said. "The biggest issue in the past is that HIV-positive women are not involved or do not seek out health care," Dr. Quinn said. "So, there are fewer numbers on anti-retroviral drugs than men."
Dr. Quinn pointed to a number of possible reasons for this disparity, including that men are more likely to be included in experimental therapy trials and that pregnant women are not allowed to enroll in them.