Data from the USA have shown that women are more likely than men to discontinue ART for poor adherence, dermatological symptoms,
neurological reasons, constitutional symptoms Selleck AZD1152HQPA and concurrent medical conditions . UK cohort data found 88.6% of men compared with 80.7% of women spent 100% of the first year after starting HAART actually on therapy . Comparison of ATV/r with LPV/r found poorer virological outcomes in treatment-naïve women compared with men. Gender differences in efficacy were due to higher discontinuation rates in women than men in both treatment arms . CNS side effects of varying severity can occur with EFV, particularly at the initiation of therapy. This may be partly explained by the greater EFV exposure associated with a CYP2B6 variant, more commonly found in Africans and African Americans . In the UK population, this is of particular relevance to women, the majority of whom are of African ethnicity. NVP-associated rash occurs more frequently in women than men . Hepatotoxicity associated with NVP is more common in women http://www.selleckchem.com/EGFR(HER).html with a CD4 cell count >250 cells/μL, restricts women’s use of the drug . A systematic review of studies on gender and ART adherence published between 2000 and 2011 in the resource-rich
world concluded that overall reported adherence is lower in women than men . However, of over 1000 studies initially identified for review, only 44 had adequate data on gender to allow any comparisons to
be made. The authors identified the particular factors for lower adherence in women were depression, lack of supportive interpersonal relationships, second young age, drug and alcohol use, black ethnicity, ART of six or more pills per day, higher numbers of children, self-perception of abdominal fat gain, sleep disturbances and increased levels of distress. Concerns about potential fetal toxicity of ARVs have influenced prescribing practice in HIV-positive women. Of note, other than ZDV in the third trimester, no ARV drug has a licence for use in pregnancy. Pregnancy in women living with HIV who are already on effective therapy is increasing; 70% of HIV-positive pregnant women in the UK in 2010 were diagnosed before the current pregnancy, of which 60% were already on ART at conception . Where newer drugs are available, women are conceiving on these agents, with ZDV now rarely used as first-line therapy for adults. European cohort data comparing pregnancies that were managed with ZDV-containing regimens vs. those without ZDV found no difference in risk of detectable VL at delivery, vertical transmission or congenital abnormality when comparing ZDV-sparing with ZDV-containing ART . The most robust data on teratogenicity and first trimester ART exposure are from the Antiretroviral Pregnancy Registry (APR) . This international prospective reporting system records rates of congenital birth defects in babies born to women with exposure to ART at any stage of pregnancy.