Antiretroviral Therapy Effects Vary Based On Race, Gender

Armen Hareyan's picture

Althoughthe overall rate of adverse events among HIV-positive people initiatingantiretroviral treatment does not differ significantly among different racesand genders, there are significant differences for specific adverse events,according to a study recently published in the Journal of Acquired ImmuneDeficiency Syndromes, Reuters Health reports. For the study, EllenTedaldi of Temple University's School ofMedicine and colleagues compared the frequency and types of adverse eventsamong 1,301 patients who were initiating antiretroviral therapy. The studyincluded 701 black participants, 225 Latinos and 273 women. The study did notfind significant differences among races or gender in regard to death from anycause or treatment withdrawal rates because of drug toxicity (ReutersHealth, 4/30).

According to the study, several "baseline characteristics" differed basedon gender and race -- including age, HIV transmission risk, hepatitis B or Ccoinfection, viral load, diagnosis of AIDS, body mass index and baselinehypertension (Tedaldi et al., JAIDS, 4/1). Cardiovascular andkidney side effects were 2.64 and 3.83 times more frequent, respectively, amongthe black participants than among white participants, the study found. Thisfinding was consistent with the increased rates of heart disease, diabetes andkidney disease found among all black men and women, the researchers noted.

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Black men experienced 2.45 times higher rates of psychiatric-related adverseevents than white men, the study showed. Tedaldi and her team said that it is"likely that grade four psychiatric adverse events represent aconstellation of factors that include psychosocial and biologicassociations," such as undiagnosed mental illness or the virus' effects onthe central nervous system.

The study found 409 grade four adverse events during an average five-yearfollow-up period, or a rate of 8.9 events per person per 100 years. Grade fourevents are considered the most severe types based on a scale of one to four.The study found that women were 2.34 times more likely to experience grade fouranemia, compared with men, according to the study. This finding was "notunexpected" because most of the women were premenopausal and black, theresearchers wrote. Researchers also recorded 176 deaths -- a rate of three perperson per 100 years. The study also recorded 523 antiretroviral discontinuationsfor any toxicity -- a rate of 13 per person per 100 years.

The researchers note that published data on the rate and types of adverseevents by gender and race are limited, concluding that the findings "couldinform HIV treating clinicians about particular issues to consider in theselection of antiretroviral regimens for diverse populations" (ReutersHealth, 4/30).

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