Effectiveness of treatment in women

Anti-HIV treatment works equally well in women and men. To find out more about specific anti-HIV treatments, see the booklets Anti-HIV Drugs and HIV Therapy in this series.

However, you may be more likely than a man to get higher blood levels of some drugs, probably because men tend to weigh more than women and the doses of anti-HIV drugs were decided after clinical trials that involved many more men than women. Gender differences in side-effects may also be due to an interaction between HIV medications and female hormones.

Having higher blood levels of a drug can mean that there's more of it available to fight HIV but, on the downside, it could mean that you might be more likely to get side-effects. For example, higher levels of the protease inhibitor indinavir in women can cause problems in the kidneys. Because of the risk of developing severe liver-related side-effects, women who have a CD4 cell count above 250 should not start treatment with the NNRTI nevirapine.

Side-effects of HIV treatment in women

Women may be more likely to get some other side-effects too, so it’s important to discuss these risks with your doctor. Some studies suggest that changes in body shape called lipodystrophy may affect women more than men. It also seems that women are more likely to get unusual fat accumulation in certain parts of the body, such as the breasts, without the fat loss that is often seen in men.
Changes in the levels of fats and sugars in the blood – cholesterol, glucose and triglycerides, increasing the risk of heart disease and stroke – are also part of lipodystrophy. The risk of heart disease or stroke from hormone replacement therapy (HRT) is increased if you have high cholesterol. If you are considering HRT and are taking antiretroviral therapy, or have high cholesterol, you should carefully consider the risks and make sure that the levels of fats and sugars in your blood monitored regularly.
To find out more, see the booklet called lipodystrophy in this series.

Women also seem to be at a greater risk of lactic acidosis, a rare but potentially fatal problem caused by some HIV treatments. Lactic acidosis is an increased lactate level (hyperlactemia) that causes muscle problems and liver damage. Moreover, women are also more likely to develop lactic acidosis faster than men. However, the development of this side-effect has been found to be more common in those who used the HIV drugs d4T (stavudine, Zerit) or ddI (didanosine, Videx), than in those who used other antiretrovirals.

A heightened risk of problems caused by exposure to certain medications in women can also be seen in the rash linked with the drug nevirapine. This increased incidence of rash may possibly warn of an increased risk for liver disease among women taking the drug. Pancreatitis (pancreas damage) has also been seen in higher rates in women on some anti-HIV drugs. Some studies also suggest a very high risk for diabetes related to HIV therapy for African-American women.

Menstrual changes associated with some protease inhibitors are one example of a side effect that can affect women but not men.

Because of these risks, women prescribed certain medications may need closer clinical and laboratory monitoring in order to avoid potential problems.