Treating women with HIV: is it different than treating men?

While antiretroviral therapy (ART) has had a tremendous impact on the morbidity and mortality of patients with HIV, there is evidence that many HIV-infected women experience treatment challenges that are different from men and these challenges are often associated with poorer outcomes. In the United States, blacks and Latino women are disproportionately affected by the HIV epidemic related to lack of access to high-quality HIV care, and socioeconomic factors. In Africa and Asia, HIV infection in women is affected by gender norms that often leave women dependent upon men (either emotionally or financially) and vulnerable in relationships. These gender norms and, in some cases, fears of violence make it difficult for women to refuse unprotected sex, and can contribute to higher infection rates in women and delayed entry to care. Many African migrants in Europe and Australia may feel stigmatized and fear discrimination when accessing care. As a consequence, despite the availability of highly active antiretroviral therapy, women with HIV often have delayed entry into care and experience poor outcomes. With the notable exception of treatment during pregnancy, there is little in the published literature to suggest that the treatment of choice for treatment-naïve patients should be determined by the patient's sex. While virologic efficacy of ART may be similar in large clinical trials, differences in the frequency of treatment-related side effects and the impact of pregnancy and/or child-bearing status on treatment choice is well documented. In this paper we aim to discuss antiretroviral therapy in HIV-infected women, the sex-specific barriers to starting care, the differences in outcomes, and complications.