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Jewish World Review March 8, 2001 / 13 Adar, 5761

Lee Bowman

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Consumer Reports

Women getting AIDS as fast as men -- Even though women with HIV start out carrying significantly lower amounts of the virus in their blood, they lose immune cells and develop AIDS just as swiftly as men, according to a new study.

The research published today backs up recent changes in AIDS treatment guidelines that place less emphasis on virus counts in determining when men and women should start taking anti-HIV drugs.

"Previous studies in men have shown that the initial viral load can be used to gauge their likelihood of progression to AIDS, but our data confirm that the initial viral load is much lower in women than men and thus not as predictive for women,'' said Dr. Thomas Quinn, a senior investigator at the National Institute of Allergy and Infectious Diseases and a co-author of the report in The New England Journal of Medicine.

The study, led by Dr. Timothy Sterling at Johns Hopkins University in Baltimore, followed more than 200 intravenous drug users diagnosed as HIV-positive for up to 10 years, measuring several factors to evaluate their risk of developing AIDS.

One of the key yardsticks doctors have been using to assess when the virus is likely to start overwhelming the immune system is to count how many copies of the virus are in a milliliter of blood, or the "viral load'' a patient is carrying. Until this year, government guidelines had suggested that when that number exceeded 20,000, it was time to start taking a "cocktail" of anti-retroviral drugs.

But in the Johns Hopkins study, the initial viral load for men averaged 50,000 copies, compared to 15,000 in women, with the differences even more pronounced in the 29 men and 15 women who went on to develop AIDS during the study.

"Despite early differences in viral load among men and women, as time went on, both men and women had a similar risk of developing AIDS,'' Sterling said. But men and women did "experience a similar rate of loss of their CD4+T cells, the immune system cells that decrease as a result of HIV infection.''

The average count of the immune cells at the time of infection was 659 per cubic millimeter of blood for men and 672 for women in the study.

Under new guidelines adopted by the Department of Health and Human Services in January, treatment is to be offered to HIV-positive patients when their cell count falls below 350 or the viral load exceeds 55,000.

Quinn said that while the study and the new guidelines should help reduce any gender bias in HIV therapy, the best point for starting the treatments still isn't known; nor are the mechanics of why the virus multiplies differently in women than men.

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