Abstract
IntroductionIn the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration. This is in spite of accumulating evidence that there are a number of potential differences between women and men which may affect response to treatment, pharmacokinetics, toxicities and coping. There are also notable psychological, behavioural, social and structural factors that may have a unique impact on women living with HIV (WLWH). Despite our increasing knowledge of HIV and advances in treatment, there are significant gaps in the data relating specifically to women. One of the factors contributing to this situation is the under-representation of women in all aspects of HIV clinical research. Furthermore, there are clinical issues unique to women, including gynaecologic and breast diseases, menopause-related factors, contraception and other topics related to women's and sexual health.MethodsUsing scoping review methodology, articles from the literature from 1980 to 2012 were identified using appropriate MeSH headings reflecting the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. Titles and abstracts were scanned to determine whether they were relevant to non-reproductive health in WLWH, and papers meeting inclusion criteria were reviewed.ResultsThis review summarizes our current knowledge of the clinical status of WLWH, particularly in the areas of clinical management, sexual health, emotional wellbeing and treatment access. It suggests that there are a number of gender differences in disease and treatment outcomes, and distinct women-specific issues, such as menopause and co-morbidities, that pose significant challenges to the care of WLWH.ConclusionsBased on a review of this evidence, outstanding questions and areas where further studies are required to determine gender differences in the efficacy and safety of treatment and other clinical and psychological issues specifically affecting WLWH have been identified. Well-controlled and adequately powered clinical studies are essential to help provide answers to these questions and to contribute to activities aimed at improving the health and wellbeing of WLWH.
Highlights
In the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration
This article was written using scoping review methodology [4] to provide a narrative account of available research in gender differences in HIV-related non-reproductive clinical factors, including ageing, emotional and sexual wellbeing, and other challenges faced by women living with HIV (WLWH)
At the time of the review there were 331,546 papers mentioning the terms ‘‘HIV’’ or ‘‘AIDS.’’ Of these, only 112,474 mentioned the word ‘‘female’’ or ‘‘women,’’ whereas 120,896 mentioned the word ‘‘male’’ or ‘‘men.’’ The papers were divided into four sections Á clinical management, emotional health, sexual health and treatment access Á based on the use of diverse MeSH headings for each section, including ‘‘HIV’’; ‘‘women’’ or ‘‘gender’’; ‘‘antiretroviral response,’’ ‘‘antiretroviral toxicity,’’ ‘‘ageing,’’ ‘‘co-morbidities,’’ ‘‘sexual health,’’ ‘‘menopause,’’ ‘‘depression’’ or ‘‘emotional wellbeing’’; and ‘‘treatment access.’’ Titles of papers were searched electronically to allocate potentially relevant articles for inclusion in a scoping review process [4]
Summary
In the management of HIV, women and men generally undergo the same treatment pathway, with gender differences being given limited consideration. Results: This review summarizes our current knowledge of the clinical status of WLWH, in the areas of clinical management, sexual health, emotional wellbeing and treatment access. It suggests that there are a number of gender differences in disease and treatment outcomes, and distinct women-specific issues, such as menopause and co-morbidities, that pose significant challenges to the care of WLWH. Where studies of women do exist, these are most often confined to the issue of pregnancy, a vital area of interest in relation to women, but not representing the totality of female experience Overcoming these barriers is crucial to increase female participation in clinical research [3] and to provide gender-specific knowledge
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