Antiretroviral combination therapy in HIV-1 infected women and men: are their responses different?

Women are the fastest growing segment of the AIDS cases in the United States. They constitute nearly half of all the AIDS cases worldwide. Recent advances in Highly Active Antiretroviral Therapies (HAART) have reduced AIDS mortality remarkably. But as longer use of these combination regimens makes evident, unexpected side effects are now reported that might reflect gender-based differences in occurrence. Controversy still exists in relation to the level of HIV-1 quantification in men and women and its association with disease progression. Women have been reported to have lower viral loads with equal progression or higher progression with equal viral loads. This finding has not been consistent in all studies. Psychosocial variables, such as poverty, lack of care and young age, adversely affect more women than men. If the viral dynamics are thought to be different, then the response to treatment might be as well. So far, the effectiveness of HAART has been seen equally among men and women. Barriers to adherence, such as caregiving burdens, multiplicity of roles and fear of disclosure, might disproportionately affect women. By far the best news is that the survival of both men and women has improved with the newer therapeutic advances.