Gender differences in HIV progression to AIDS and death in industrialized countries: slower disease progression following HIV seroconversion in women.
To evaluate sex differences in human immunodeficiency virus (HIV) disease progression before (pre-1997) and after (1997-2006) introduction of highly active antiretroviral therapy, the authors used data from a collaboration of 23 HIV seroconverter cohort studies from Europe, Australia, and Canada restricted to the 6,923 seroconverters infected through injecting drug use and sex between men and women. Within a competing risk framework, they used Cox proportional hazards models allowing for late entry to evaluate sex differences in time from HIV seroconversion to death, to acquired immunodeficiency syndrome (AIDS), and to each first AIDS-defining disease and death without AIDS. While no significant sex differences were found before 1997, from 1997 onward, women had a lower risk of AIDS (adjusted cumulative relative risk (aCRR) = 0.76, 95% confidence interval (CI): 0.63, 0.90) and death (adjusted hazard ratio = 0.68, 95% CI: 0.56, 0.82) than men did. Compared with men, women also had lower risks of AIDS dementia complex (aCRR = 0.23, 95% CI: 0.07, 0.74), tuberculosis (aCRR = 0.60, 95% CI: 0.39, 0.92), Kaposi's sarcoma (aCRR = 0.27, 95% CI: 0.07, 0.99), lymphomas (aCRR = 0.47, 95% CI: 0.23, 0.96), and death without AIDS (aCRR = 0.74, 95% CI: 0.56, 0.98). Sex differences in HIV disease progression have become larger and statistically significant in the era of highly active antiretroviral therapy, supporting a stronger impact of health interventions among women.
Jarrin
Inmaculada
I
National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
Geskus
Ronald
R
Bhaskaran
Krishnan
K
Prins
Maria
M
Perez-Hoyos
Santiago
S
Muga
Roberto
R
Hernández-Aguado
Ildefonso
I
Meyer
Laurence
L
Porter
Kholoud
K
del Amo
Julia
J
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001315:Australia / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D016001:Confidence Intervals; D019049:Developed Countries / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D006679:HIV Seropositivity; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012306:Risk; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications