This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

The Terry Beirn Community Programs for Clinical Research on AIDS

Sandra L. Melnick, DrPH; Renslow Sherer, MD; Thomas A. Louis, PhD; David Hillman, MS; Evelyn M. Rodriguez, MD; Cheryl Lackman, MPH; Linnea Capps, MD; Lawrence S. Brown, Jr, MD; Marcia Carlyn, PhD; Joyce A. Korvick, MD; Lawrence Deyton, MD, MSPH; for the Terry Beirn Community Programs for Clinical Research on AIDS; Stanley Johns, MD, CTC; Jacquelyn Ellison, LPN; Micheal J. Hickson, MD; Janet Lee, MD; Melanie Thompson, MD; Terri Creagh, PhD; Amy Morris, MBA; Jerome Ernst, MD; Cathy Pollard, RPA-C; Kathryn Anastos, MD; Mordechai Bar, MD; Elizabeth Doramajian, MS; David Blatt, MD; David Moore, DO; Renee Renzetti, RN; Rita Verheggen, RN; Roberta Luskin-Hawk, MD; Ramon A. Torres, MD; David Townley; Kathleen Clanon, MD; Bea Morris, PA; William Owen, MD; Carol Brosgart, MD; Lawrence R. Crane, MD; Jack Ebright, MD; Paula Schuman, MD; William Valuer, MSW; Colleen Fairclough, RN, BN; William J. Holloway, MD; Dean Winslow, MD; Susan Szabo, MD; Arlene Bincsik, RNC, MS; Karen Swanson, RNC, BSN; David L. Cohn, MD; Randall R. Reves, MD; Michael J. Grodesky, BSN; Carol A. Mesard, RN; Joan E. Gans, BSN; Wafaa El-Sadr, MD, MPH; Linnea Capps, MD, MPH; Cheryl Guity, RN; Michelle Hardy; Luis Fuentes, MPH; Louis Saravolatz, MD; Norman Markowitz, MD; Jones Kumi, MD; Diane Mastro-Polak, RN, BSN; Jill Hutchinson, AD; Janice Walker, RN, MN; Sue Pablovich, Sr, RN, NP, MPH; Phyllis Simmons, RN; Nancy Kimmel, RN; Jeffrey Kocher, MD; Steven Weisholtz, MD; Annemarie Sheridan, RN; Victoria M. Taylor, RN; Jilleen Braithwaite; James H. Sampson, MD; Joel Godbey, MD; Mark Loveless, MD; Catherine Salveson, RN; Norma Martinez, RN; Thomas M. Kerkering, MD; Carol Webster, RN, MPH; Evelyn Fisher, MD; Kurt Link, MD; Lawrence Gernon, MD; Ami Labriola, MD; Cynthia Gibert, MD; John Scott, RNC; Elizabeth Finley, RN, ANP; Karen Irvin, RN, MEd; James D. Neaton, PhD; Tim Brelje, MS; Alain DuChene; Greg Thompson; Deborah N. Wentworth, MPH; Lawrence R. Deyton, MSPH, MD; Jane Sanvffle, MPH; Mary Foulkes, PhD

JAMA. 1994;272(24):1915-1921.

Abstract
Objective.
—To compare disease progression and mortality between women and men infected with human immunodeficiency virus (HIV).

Design.
—Multicenter cohort.

Setting.
—Seventeen community-based centers participating in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA).

Patients.
—A total of 768 women and 3779 men enrolled in one or more of 11 protocols between September 7, 1990, and September 30, 1993.

Main Outcome Measures.
—Survival and opportunistic events.

Results.
—The median CD4⁺ cell count at enrollment into the cohort was 0.240 x10⁹/L (240/µL) for women and 0.137 x10⁹/L for men (P<.001). Compared with men, women were younger (36 vs 38 years), more likely to be African American or Hispanic (78% vs 44%), and more likely to have reported a history of injection drug use (49% vs 27%). Women had been followed up for a median of 14.5 months and men for 15.5 months. The adjusted relative risk (RR) for death among women compared with men was 1.33 (95% confidence interval [CI], 1.06 to 1.67; P=.01) and for disease progression (including death) was 0.97 (95% CI, 0.82 to 1.15; P=.72). Women were at increased risk for bacterial pneumonia (RR, 1.38; 95% CI, 1.05 to 1.92) and at reduced risk for the development of Kaposi's sarcoma (RR, 0.16; 95% CI, 0.04 to 0.65) and oral hairy leukoplakia (RR, 0.54; 95% CI, 0.31 to 0.94). The increased risk of death and bacterial pneumonia for women compared with men was primarily evident among those with a history of injection drug use (RR, 1.68 for death, 95% CI, 1.20 to 2.35, P=.003; RR, 1.53 for bacterial pneumonia, 95% CI, 1.03 to 2.29, P=.04). Among patients without a history of disease progression at entry, death was the first event reported for more women than men (27.5% vs 12.2%).

Conclusions.
—Compared with men, HIV-infected women in the CPCRA were at increased risk of death but not disease progression. Risks of most incident opportunistic diseases were similar for women and men; however, women were at an increased risk of bacterial pneumonia. These findings may reflect differential access to health care and standard treatments or different socioeconomic status and social support for women compared with men.

(JAMA. 1994;272:1915-1921)

Author Affiliations
From the Division of Epidemiology (Dr Melnick) and Division of Biostatistics (Dr Louis and Mr Hillman), School of Public Health, University of Minnesota, Minneapolis; Cook County HIV Primary Care Center, Cook County Hospital, Chicago, Ill (Dr Sherer); Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md (Drs Rodriguez, Korvick, and Deyton); Bronx (NY) Perinatal Consortium (Ms Lackman); Division of Infectious Diseases, Columbia University/Harlem Hospital Center, New York, NY (Dr Capps); Addiction Research and Treatment Corporation, Brooklyn, NY, and Harlem Hospital College of Physicians and Surgeons, Columbia University, New York, NY (Dr Brown); and Prospect Associates, Rockville, Md (Dr Carlyn). Dr Melnick is currently with the Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.

Addiction Research and Treatment Corporation; AIDS Research Consortium of Atlanta, Inc.; Bronx-Lebanon Hospital Center; Chicago Community Program for Clinical Research on AIDS; Clinical Directors Network of Region II, Inc.; Community Consortium; Comprehensive AIDS Alliance of Detroit; Delaware Community Program for Clinical Research on AIDS; Denver Community Program for Clinical Research on AIDS; Harlem AIDS Treatment Group; Henry Ford Hospital; Louisiana Community AIDS Research Program; North Jersey Community Research Initiative; The Research and Education Group; Richmond AIDS Consortium; Washington Regional AIDS Program; Statistical Center; Division of AIDS

Footnotes
Reprint requests to Epidemiology Branch, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 6003 Executive Blvd, Room 2C09, MSC 7620, Bethesda, MD 20892-7620 (Dr Melnick).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Epidemiological Characterization of Individuals With Newly Reported HIV Infection: South Carolina, 2004-2005
Ogbuanu et al.
AJPH 2009;99:S111-S117.
ABSTRACT | FULL TEXT  

Gender Differences in HIV Progression to AIDS and Death in Industrialized Countries: Slower Disease Progression Following HIV Seroconversion in Women
Jarrin et al.
Am J Epidemiol 2008;168:532-540.
ABSTRACT | FULL TEXT  

Gender differences in progression to AIDS and death from HIV seroconversion in a cohort of injecting dug users from 1986 to 2001
de la Hera et al.
J. Epidemiol. Community Health 2004;58:944-950.
ABSTRACT | FULL TEXT  

Human Immunodeficiency Virus Infection: A Focus on Women
Pakyz et al.
Journal of Pharmacy Practice 2003;16:170-181.
ABSTRACT  

Evaluation and Management of HIV-Infected Women
Levine
ANN INTERN MED 2002;136:228-242.
ABSTRACT | FULL TEXT  

Hospitalization in HIV in Chicago
Sherer et al.
J Int Assoc Physicians AIDS Care (Chic Ill) 2002;1:26-33.
ABSTRACT  

Initial Plasma HIV-1 RNA Levels and Progression to AIDS in Women and Men
Sterling et al.
NEJM 2001;344:720-725.
ABSTRACT | FULL TEXT  

HIV Infection in Women in the United States: Status at the Millennium
Hader et al.
JAMA 2001;285:1186-1192.
ABSTRACT | FULL TEXT  

Discontinuation of Mycobacterium avium Complex Prophylaxis in Patients with Antiretroviral Therapy-Induced Increases in CD4+ Cell Count: A Randomized, Double-Blind, Placebo-Controlled Trial
Currier et al.
ANN INTERN MED 2000;133:493-503.
ABSTRACT | FULL TEXT  

Marked Declines in Human Immunodeficiency Virus-Related Mortality in Chicago in Women, African Americans, Hispanics, Young Adults, and Injection Drug Users, From 1995 Through 1997
Whitman et al.
Arch Intern Med 2000;160:365-369.
ABSTRACT | FULL TEXT  

Neurocognitive Impairment Is an Independent Risk Factor for Death in HIV Infection
Ellis et al.
Arch Neurol 1997;54:416-424.
ABSTRACT  

Human Immunodeficiency Virus--Related Oral Manifestations and Gender: A Longitudinal Analysis
Shiboski et al.
Arch Intern Med 1996;156:2249-2254.
ABSTRACT  

Struggles with Symptoms: Women's Narratives of Managing HIV Illness
Stevens
J Holist Nurs 1996;14:142-160.
ABSTRACT  

Race, Sex, Drug Use, and Progression of Human Immunodeficiency Virus Disease
Chaisson et al.
NEJM 1995;333:751-756.
ABSTRACT | FULL TEXT  

Women with HIV May Die Sooner Than Men . . .
JWatch Psychiatry 1995;1995:20-20.
FULL TEXT  

Prognosis for HIV-infected Women
AIDS Clin Care 1995;1995:10-10.
FULL TEXT  

WOMEN WITH HIV DIE SOONER THAN MEN
JWatch General 1995;1995:1-1.
FULL TEXT