title: Relevant gender differences in epidemiological profile, exposure to first antiretroviral regimen and survival in the Spanish AIDS Research Network Cohort.
abstract: BACKGROUND
  The possible differences in the disease spectrum and prognosis of HIV infection in women and men is a major point of concern. Women are under-represented in randomized clinical trials and in some cohorts. Discordant results have often been obtained depending on the setting.
  
  
  METHODS
  We assessed gender differences in clinical and epidemiological features, antiretroviral treatment (ART) exposure and survival in two multicentre cohorts of HIV-positive subjects in Spain: CoRIS-MD and CoRIS. Competing risk regression models were used to assess gender effect on time to start ART and time to first ART change, and a Cox regression model to estimate gender effect on time to death.
  
  
  RESULTS
  Between January 1996 and December 2008, 1,953 women and 6,072 men naive to ART at study entry were included. The trend analysis over time showed the percentage of women in the younger (<20 years) and older (>50 years) strata increased significantly (P<0.001) from 0.5% and 1.8% in 1996 to 4.9% and 4.2% in 2008, respectively. By competing risk analysis women started ART earlier than men (adjusted subhazard ratio [ASHR] 1.21, 95% CI 1.11, 1.31) in CoRIS cohort, while in CoRIS-MD none of these differences were observed. In both cohorts women showed a shorter time to the first ART change (ASHR 1.10, 95% CI 1.01, 1.19). Pregnancy and patient's/physician's decisions as reasons for changing were more frequent in women than in men in CoRIS. In the Cox regression model, gender was not associated with differences in survival.
  
  
  CONCLUSIONS
  In two large cohorts in Spain, we observed relevant gender differences in epidemiological characteristics and antiretroviral exposure outcomes, while survival differences were not attributable to gender.
authors.affiliation: Infectious Diseases Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain. mjperez90@gmail.com.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Pérez-Elías
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.forename: Ana
authors.initials: A
authors.lastname: Moreno
authors.forename: María
authors.initials: M
authors.lastname: Martinez-Colubi
authors.forename: José A
authors.initials: JA
authors.lastname: Iribarren
authors.forename: Mar
authors.initials: M
authors.lastname: Masiá
authors.forename: José R
authors.initials: JR
authors.lastname: Blanco
authors.forename: Rosario
authors.initials: R
authors.lastname: Palacios
authors.forename: Jorge
authors.initials: J
authors.lastname: Del Romero
authors.forename: Desire G
authors.initials: DG
authors.lastname: Pérez
authors.forename: Victoria
authors.initials: V
authors.lastname: Hernando
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents