Sex Differences in HIV Infection

• Published in: Current HIV/AIDS reports 2018-04, Vol.15 (2), p.136-146
• Main Author: Scully, Eileen P.
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral drugs; Disease prevention; Drug metabolism; Gender differences; HIV; HIV Pathogenesis and Treatment (AL Landay and N Utay; HIV Pathogenesis and Treatment (AL Landay and N Utay, Section Editors); Human immunodeficiency virus; Latency; Medicine; Medicine & Public Health; Microbiomes; Pathogenesis; Prophylaxis; Section Editors; Sex differences; Sex hormones; Topical Collection on HIV Pathogenesis and Treatment; Vagina; Women
• ISSN: 1548-3568; 1548-3576
• DOI: 10.1007/s11904-018-0383-2

Purpose of Review This review will outline the multilevel effects of biological sex on HIV acquisition, pathogenesis, treatment response, and prospects for cure. Potential mechanisms will be discussed along with future research directions. Recent Findings HIV acquisition risk is modified by sex hormones and the vaginal microbiome, with the latter acting through both inflammation and local metabolism of pre-exposure prophylaxis drugs. Female sex associates with enhanced risk for non-AIDS morbidities including cardiovascular and cerebrovascular disease, suggesting different inflammatory profiles in men and women. Data from research on HIV cure points to sex differences in viral reservoir dynamics and a direct role for sex hormones in latency maintenance. Summary Biological sex remains an important variable in determining the risk of HIV infection and subsequent viral pathogenesis, and emerging data suggest sex differences relevant to curative interventions. Recruitment of women in HIV clinical research is a pathway to both optimize care for women and to identify novel therapeutics for use in both men and women.