Yasmin Williams - HEALTH-WISEWHILE WOMEN and men generally manifest the same symptoms and signs and complications of HIV infection, women may suffer gender specific symptoms. Persistent low-grade fever, fatigue and weight loss are some of the non specific symptoms in both men and women. Recurrent vaginal yeast infections resistant to treatment is one of the gender specific symptoms in women. Kaposi sarcoma is a cancer which occurs in HIV infected persons. HIV infected men are said to be eight times more likely to get this cancer compared to HIV infected women. The metabolic abnormalities that result from anti retroviral drug therapy given specifically to prevent the replication or multiplication of the virus in the body have also been reported as being different in women and men.
Often there are gender related differences with respect to access to care. Women often have to put the needs of other family members,(for example their children and other more sick adult members) before their own needs resulting in more physical and emotional burden and possibly less ability to adhere to required drug treatment regimes. The National Institute of Allergy and Infectious Disease in the USA, is studying the course of HIV/AIDs in women primarily through two main studies: the Women's Interagency HIV Study (WIHS) and the Infant's Transmission Study.
The Adult AIDs Clinical Trials Group (AACTG), the Pediatric Aids Clinical Trials Group (PACTG) and the Terry Beirn Community Programs for Clinical Research on AIDs (CPCRA) are other-related
studies.
These studies will highlight gender specific differences in disease progression, complications, treatment, impact of hormonal factors and ageing as well as impact of the presence of other disease such as hepatitis C.
Data from the WIHs Study indicate that since the start of the use of the triple cocktail - highly active anti-retroviral therapy (HAART) for the treatment of HIV/AIDS, the deaths or mortality from HIV/AIDS has decreased dramatically. This decrease was twenty one per cent (21%) for women who had AIDS (later stage of HIV infection) and eleven per cent (11%) for those who were in the earlier stages of infection. The researchers also looked at the change in the measure of amount of HIV in the blood (viral load) as well as the change in numbers of the white blood cells which are part of the immune system protecting the body (CD4/CD8 cells). Its is reported that women with AIDs had the greatest improvement in the CD4 count and viral load. The WIHs study has also yielded information which may be important for resource settings like ours. The study found that women who had low levels of a protein found in the blood called albumin and high levels of another protein called C - reactive protein were more at risk for death. These tests are cheap and can be used to support clinical decisions which may have to be made in the absence of costly specific lab tests.
Currently only some patients with HIV/AIDS have been able to access CD4 counts locally at the University Hospital of the West Indies at the high cost of Ja $6,000 and viral loads at approximately US$100. Last week I went to a multi-disciplinary Caribbean conference focusing on scaling up access to anti-retroviral drugs in the Region. At the last session of the conference, it was announced that the Jamaica National HIV/STD programme is in the process of providing capacity for CD4 counts and possibly viral load monitoring at the National Public Health Lab. This will be an important resource for those who care for HIV infected persons women, men and children.
Dr. Yasmin Williams is a Family Doctor and Public Health Specialist;
email: yourhealth@gleanerjm.com.
