title: Severe morbidity according to sex in the era of combined antiretroviral therapy: the ANRS CO3 Aquitaine Cohort.
abstract: OBJECTIVE
  To describe trends and determinants of severe morbidity in HIV-infected women and men.
  
  
  METHODS
  A French prospective cohort of HIV-infected patients of both sexes and all transmission categories.
  
  
  METHODS
  We used hospital admission data from January 2000 to December 2008. A severe morbid event (SME) was defined as a clinical event requiring hospitalization for ≥48 h, several events could be reported during hospitalization. Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations.
  
  
  RESULTS
  Among 4,987 patients (27% women), followed for a median of 8.7 years, 1,473 (30%) were hospitalized (3,049 hospitalizations for 5,963 SME). The yearly incidence rate of hospitalization decreased in men, from 155 in 2000 to 80/1,000 person-years (PY) in 2008 and in women, from 125 to 71/1,000 PY, (p<0.001). This trend was observed for all SME except for hepatic events, stable in men (15 to 13/1,000 PY) and increasing in women (2.5 to 11.5), cardiovascular events increasing in men (6 to 10/1,000 PY) and in women (6 to 14) and non-AIDS non-hepatic malignancies increasing in men (4 to 7/1,000 PY) and stable in women (2.5). Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME.
  
  
  CONCLUSIONS
  HIV-infected individuals in care in France require less and less frequently hospitalization. Women are now presenting with severe hepatic and cardio-vascular events. Disparities in SME between men and women are primarily explained by different exposure patterns to risk factors. Women should be targeted to benefit cardiovascular prevention policies as well as men.
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France.
authors: Mojgan
authors: M
authors: Hessamfar
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France.
authors: Céline
authors: C
authors: Colin
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France.
authors: Mathias
authors: M
authors: Bruyand
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France.
authors: Madeleine
authors: M
authors: Decoin
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France.
authors: Fabrice
authors: F
authors: Bonnet
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU Bordeaux, Service de Médecine Interne et Immunologie Clinique, Bordeaux, France.
authors: Patrick
authors: P
authors: Mercié
authors: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU de Bordeaux, Fédération des Maladies Infectieuses et Tropicales, Bordeaux, France; Université de Bordeaux, Bordeaux, France.
authors: Didier
authors: D
authors: Neau
authors: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU de Bordeaux, Fédération des Maladies Infectieuses et Tropicales, Bordeaux, France; Université de Bordeaux, Bordeaux, France.
authors: Charles
authors: C
authors: Cazanave
authors: Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France; Université de Bordeaux, Bordeaux, France.
authors: Jean-Luc
authors: JL
authors: Pellegrin
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France.
authors: François
authors: F
authors: Dabis
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France.
authors: Philippe
authors: P
authors: Morlat
authors: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France.
authors: Geneviève
authors: G
authors: Chêne
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005602:France; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D012737:Sex Factors