Survival and disease progression according to gender of patients with HIV infection. The Terry Beirn Community Programs for Clinical Research on AIDS.

OBJECTIVE: To compare disease progression and mortality between women and men infected with human immunodeficiency virus (HIV). DESIGN: Multicenter cohort. SETTING: Seventeen community-based centers participating in the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA). PATIENTS: A total of 768 women and 3779 men enrolled in one or more of 11 protocols between September 7, 1990, and September 30, 1993. MAIN OUTCOME MEASURES: Survival and opportunistic events. RESULTS: The median CD4+ cell count at enrollment into the cohort was 0.240 x 10(9)/L (240/microL) for women and 0.137 x 10(9)/L for men (P < .001). Compared with men, women were younger (36 vs 38 years), more likely to be African American or Hispanic (78% vs 44%), and more likely to have reported a history of injection drug use (49% vs 27%). Women had been followed up for a median of 14.5 months and men for 15.5 months. The adjusted relative risk (RR) for death among women compared with men was 1.33 (95% confidence interval [CI], 1.06 to 1.67; P = .01) and for disease progression (including death) was 0.97 (95% CI, 0.82 to 1.15; P = .72). Women were at increased risk for bacterial pneumonia (RR, 1.38; 95% CI, 1.05 to 1.92) and at reduced risk for the development of Kaposi's sarcoma (RR, 0.16; 95% CI, 0.04 to 0.65) and oral hairy leukoplakia (RR, 0.54; 95% CI, 0.31 to 0.94). The increased risk of death and bacterial pneumonia for women compared with men was primarily evident among those with a history of injection drug use (RR, 1.68 for death, 95% CI, 1.20 to 2.35, P = .003; RR, 1.53 for bacterial pneumonia, 95% CI, 1.03 to 2.29, P = .04). Among patients without a history of disease progression at entry, death was the first event reported for more women than men (27.5% vs 12.2%). CONCLUSIONS: Compared with men, HIV-infected women in the CPCRA were at increased risk of death but not disease progression. Risks of most incident opportunistic diseases were similar for women and men; however, women were at an increased risk of bacterial pneumonia. These findings may reflect differential access to health care and standard treatments or different socioeconomic status and social support for women compared with men.

Is maternal serum heat stable alkaline phosphatase an index of fetal maturity?

A cross sectional estimation of serum heat stable alkaline phosphatase (HSAP) levels in 145 women with uncomplicated pregnancies between 24-41 weeks gestation showed increasing levels with advancing gestation and a steep rise at about 34 weeks gestation from a mean level of 17.3 +/- 6.5 micrograms/ml to a mean level of 36.1 +/- 1.5 micrograms/ml (t = 7.4 p less than .001) at about 37 weeks gestation. Ninety-three point seven percent (93.7%) and 24.4% of women between 31-35 weeks gestation and 27-34 weeks gestation respectively had levels equal to or exceeding 20 micrograms/ml. It is postulated that serum HSAP represent stages of fetal maturity rather than gestational age per se and that there is a possible relationship between serum HSAP and amniotic fluid lecithin viewed against a background of a similar rise of amniotic fluid lecithin levels at about 33 weeks gestation and the common role of steroid receptor sites in the formation of both HSAP and Lecithin.

A demand function for the New York City abortion market.

PIP: The 1970 abortion law in New York State made abortion on request legal. A sudden increase in demand for abortions was anticipated. In order to plan for the development of free-standing abortion clinics in New York City to meet this anticipated demand, the nature of their demand function was calculated. The clients of these free-standing clinics were mainly white, high-income women from outside New York City. Surprisingly enough, given the urgency of need situation of many of the prospective clients, the demand was found to be highly elastic. In other words, higher prices caused a lowering of demand for the abortion services. It is assumed that alternative services were used instead.^ieng