DiffErEnt !

Due to advances in research and the arrival of tritherapies, people who are HIV positive are now faced with « long-term » treatments. In this framework, research on treatments and their side effects can’t go on ignoring women, because biological differences do exist and must be taken into account.

At present, the specific conditions of HIV positive women are only studied within a social dimension. In order to include them, certain population groups are targeted : women on drugs, African women, prostitutes. And they can only be a subject for research to the extent that they are « useful » to society, that is as mothers.

During conferences and colloquia, at least one observation is shared by doctors : clinical tests on women infected by HIV are rare-except as far as the mother-child transmission. And when they are concentrated on these particular results, one has to admit that there are differences between the sexes.

Osteoporosis is a flagrant example. As a matter of fact, women are subject overall to progressive bone decalcification at the time of menopause. It’s possible we will be seeing an accumulation of factors, and that these symptoms will be reinforced, in those women who are HIV-positive, through side effects of the treatments used against HIV.

Another example illustrates the disastrous effects of not having specific feminine aspects taken into consideration on the therapeutic level :

In January 2001, the results of an American study on nevirapin (Viramune®) show that side effects are more frequent and more serious in women. This study was done because in the framework of mother-child transmission, nevirapin has been mass-prescribed. And its having been mass-prescribed is what led us to the necessary observation that women had different reactions from men, such as skin rashes (seven times higher in women than in men for reasons still unknown to this day) and high levels of liver attacks. Before this study, women had once again discovered at their expense the difference in impact of treatments : not only were the reactions to nevirapin stronger in women, but they also caused death in some of them.

A year later, results of a comparative study confirm a clear tendency for women to be overexposed to nevirapin. This study was done on few patients, but was perfectly equal for both sexes. It was supposed to compare the pharmacocinetic profiles between men and women of this antiviral.

Researchers inferred from this that applying standardized dosage is what causes this overexposure. They therefore advise prescribers to adapt it according to the patient’s weight.

Only recently neuro-psychiatric complications, depression, sleep disturbances are also mentioned… What else will be discovered ? Most of all, how much more time do we have to wait for women to die of side effects before specific studies are developed ?

Biomedical research has started to confirm more and more the importance of recruiting women in clinical tests, so as to determine and measure the differences as far as side effects. This is overdue.

It is overdue today, to act on the fact that current dosages of medicine do not take the patient’s weight into account, that the hormonal system represents a fundamental difference between men and women, that their cycle influences the virological and immunological markers, that this cycle may be disturbed by side effects , that because of lipid imbalances undoubtedly they won’t age the way men do…

Until very recently, research only considered women as « problems » they might pose, as complications they might bring into the testing : there was the fear that they could be pregnant during tests, the women found themselves eliminated from some tests because they would falsify the data.

But what scientific data are we discussing, if it excludes women’s bodies from the field of medical research ? Up until now, the model for bodies that medicine studies is the man’s body. It is time to change this perception of things.

The emergency today is not so much representing women in numbers in testing, as it is in the responses that should be given to infection itself as well as in the evolution of illness, treatments and their side effects in women.