The impact of gender on the progression of neuromanifestation in HIV infection

ZUSAMMENFASSUNG

Ds Geschlecht hat einen besonderen Einfluss auf den Verlauf, die Manifestationen und die Behandlung einer HIV-Infektion. Es ist aber nur wenig bekannt über den spezifischen Einfluss des Geschlechts auf die Neuromanifestation. Wir wollten daher Unterschiede in der Prävalenz und in dem Grad der Neuromanifestationen zwischen Frauen und Männern mit HIV-Infektionen evaluieren und haben deshalb eine Fall-Kontroll-Studie mit konsekutiven HIV-infizierten Frauen (n = 167) and Männern (n = 169) durchgeführt, die für die Dauer der Infektion gematcht waren. Die Studie wurde an einer überregionalen HIV-Ambulanz einer neurologischen und an einer medizinischen Klinik durchgeführt. Es wurden die demografischen, klinischen, neurologischen, neurophysiologischen (ereigniskorrelierte Potenziale, Neurografie) und Bildgebungsdaten verglichen. Frauen waren zum Zeitpunkt der Infektion signifikant jünger als Männer. Sie zeigten weniger fortgeschrittene Stadien der HIV-Infektion und eine höhere CD4⁺-Zellzahl. Frauen erhielten seltener eine antiretrovirale Therapie. Die Nervenleitgeschwindigkeiten und Latenzen der ereigniskorrelierten Potenziale waren signifikant besser bei Frauen. Sie hatten eine signifikant niedrigere Rate einer Polyneuropathie und von generalisierten opportunistischen Infektionen. Außerdem zeigte sich ein Trend zu einer geringeren Rate einer HIV-assoziierten Enzephalopathie bei Frauen. Zusammenfassend zeigten Frauen einen besseren immunologischen Status und eine geringere Rate von Neuromanifestationen im Vergleich zu Männern mit derselben Infektionsdauer.

ABSTRACT

Gender has a considerable impact on the course, the manifestations, and the treatment of HIV infection. However, only little is known on the specific impact on neuromanifestation of HIV infection. We tried to investigate differences in the prevalence and severity of neuromanifestations between female and male HIV-infected patients and designed a case-control study with consecutive HIV-infected women (n = 167) and HIV-infected men (n = 169) matched for duration of infection. The study was performed in a supraregional HIV outpatient clinic of a neurological and of a medical university department. It included the review of demographic, clinical, neurological, neurophysiological (event-related potentials, neurography), and brain imaging data. Women were significantly younger at the time of infection. They showed less severe stages of the HIV infection and higher CD4 + cell counts. However, they were significantly more often under no antiretroviral therapy. Nerve conduction and latencies of event-related potentials were found to be significantly better in women. There were significantly lower rates of polyneuropathy and of generalized opportunistic infections and a trend to a lower rate of HIV-associated neurocognitive disorders in women. In summary, women exhibit a better immunological state and a lower rate of neuromanifestations as compared to men with the same duration of infection.

Schlüsselwörter

Geschlecht - Neuromanifestation - HIV-Infektion - AIDS

Key words

Gender - neuromanifestation - HIV infection - AIDS

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