Epidemiological and Clinical characteristics of women with HIV. WINGS Cohort Study.

1. Epidemiological and Clinical characteristics of women with HIV. WINGS Cohort Study. Louisville. 2006 - 2011. Jorge Perez San Juan, MD1, Syed Hussain, MD1, Rehab Abdelfattah, MD1, Rebecca Ford, MPH1, Bobbi Andriakos, NP1,Maikel Danger-Guillen, MD1, Robert Kelley, Ph.D. 1, Raul Nakamatsu, MD, 1,2. 1 Division of Infectious Diseases, University of Louisville, Louisville, Kentucky 2 Robley Rex VA Medical Center ABSTRACT INTRODUCTION (Cont’d) RESULTS (Cont’d) MATERIALS AND METHODS (Cont’d) Introduction: One of the most significant trends in the HIV epidemic in the US is the increasing number of women that are becoming infected. The Women’s Interagency HIV Study (WIHS), the largest study of HIV infected females in the US, is mostly representative of the epidemic in large metropolitan cities. HIV epidemiological data of females from smaller cities and rural communities are scarce. The objective of this study was to describe the epidemiological and clinical characteristics in a cohort of women with HIV infection from the WINGS Clinic Women’s Cohort (WCWC) study, and compare it to the data from WIHS. Methods: This was a retrospective observational study of 164 HIV-infected female patients managed at the Wings Clinic at the University of Louisville in Louisville, KY from 2006 to 2011. Demographic and clinical data were collected, analyzed and compared with the results from the WIHS. Results: Themedian age was 45 years, compared to 40 years in the WIHS study, the percentage of patients over 50 years old was 28.7% compared to 7% in WHIS. The main risk factor was heterosexual transmission with 94% of the cases, compared with 42% in WHIS. The most important differences in comorbidities were in Hypertension 43% compared to 18% in WHIS, and Diabetes Mellitus 16% in WCWC compared to 4.6% in WIHS. Conclusion: This study outlines the first epidemiological description of HIV infected females in the Kentuckiana region. Our findings of an extremely high rate of heterosexual transmission in our community emphasizes the importance of suspecting HIV infection in females without the classical risk factors for acquisition of HIV. The aging of our local HIV female population explains the increased frequency of medical comorbidities such as hypertension and diabetes. Globally, few studies focus on the epidemiology and characteristics of HIV infected women; of those that do (e.g. WIHS) many of them characterize populations from large metropolitan areas. However some reports indicate an increasing number of women with AIDS are from rural and smaller metropolitan areas rather than large urban centers.6 Then, there is a the need for more studies in HIV infected women globally and particularly in smaller metropolitan areas such as Louisville. The WINGS Clinic at the University of Louisville Hospital in Louisville, KY, has for more than 10 years served the needs of HIV infected patients in Kentuckiana which includes Jefferson County, Kentucky and the 13 counties from Kentucky and Southern Indiana that surround it. Our access to this facility provided us with the opportunity to perform a study with the objective of describing the characteristics of HIV infected women in our smaller metropolitan area and comparing them with the results of the WIHS study. Our study is the first epidemiological description of HIV infected women in the Kentuckiana region. Figure 4 Comparison of the Co-morbidities results of WCWC and WIHS National cohort. Statistical Analysis Descriptive statistics were calculated for all variables. Data are presented in frequencies and percentages in bar charts. RESULTS Results: Results of the study can be seen in Figures 2, 3 and 4. Figure 2 Comparison of the Demographics results of WCWC and WIHS National cohort. Figure 1 Louisville-Jefferson County, KY-IN Metropolitan Statistical Area CONCLUSIONS • This study outlines the first epidemiological description of HIV infected females in the Kentuckiana region. Our findings show: • That universal HIV testing in any female who is sexually active in Kentuckiana is extremely important since heterosexual contact is the most common risk factor for this population. • Further, the increased frequency of diabetes and hypertension may be explained by the higher median age of this population. REFERENCES INTRODUCTION Prevention, D. o. H. A. and V. H. National Center for HIV/AIDS, STD, and TB Prevention. (August 10, 2011, August 10, 2011). "HIV among Women." Retrieved 09/05/2012, 2012, from http://www.cdc.gov/hiv/topics/women/index.htm. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report. 2008; Vol 20, 2010. Bacon MC, von Wyl V, Alden C, Sharp G, Robison E, Hessol N, et al. The Women's Interagency HIV Study: an observational cohort brings clinical sciences to the bench. ClinDiagn Lab Immunol. 2005 Sep;12(9):1013-9. BarkanSE, Melnick SL, Preston-Martin S, Weber K, Kalish LA, Miotti P, et al. The Women's Interagency HIV Study. WIHS Collaborative Study Group. Epidemiology. 1998 Mar;9(2):117-25. Hughes M. The women's interagency HIV study (WIHS): research findings. Surviv News (Atlanta Ga). 2002 Mar:1. HaderSL, Smith DK, Moore JS, Holmberg SD. HIV infection in women in the United States - Status at the millennium. Jama-Journal of the American Medical Association. 2001 Mar 7;285(9):1186-92. In the beginning of the HIV epidemic in the 1980’s, the majority of the reported cases were males, mostly in the homosexual population. Consequently, the majority of research studies were focused on men, with less attention on the female population. However, as the number of women infected with HIV has increased in recent years this population has garnered more scrutiny. In 2009, the CDC reported 11,200 new HIV infections among women in the United States. That year, women comprised 51% of the US population and 23% of those newly infected with HIV, and of the total number of new HIV infections in US women 57% occurred in blacks, 21% were in whites, and 16% were in Hispanics/Latinas.1,2 Most women are reported to be infected with HIV through heterosexual sex and some women become infected because they may be unaware of a male partner’s risk factors for HIV infection or have a lack of HIV knowledge and lower perception of risk. 1,2 The Women’s Interagency HIV Study (WIHS) is a multicenter AIDS cohort study initiated in 1983, with six sites across the United States. The goal of the study was to characterize the natural progression of HIV in women; it is the largest cohort study in HIV infected women in the US. 3,4,5 Figure 3. Comparison of the Risk Factors of WCWC and WIHS National cohort. MATERIALS AND METHODS Study Design and Population This was a retrospective observational study of 164 HIV-infected female patients managed at the Wings Clinic, in Louisville, KY, from 2006 to 2011. Study Variables Variables collected were classified as demographic, risk factors and comorbidities. Study variables were manually collected from the Wings Clinic electronic medical records, into a paper data collection form, and then transferred to the electronic database, after that the data were analyzed and compared with the results of the WIHS.