title: Differential Survival for Men and Women with HIV/AIDS-Related Neurologic Diagnoses.
abstract: OBJECTIVE
  Neurologic complications of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) frequently lead to disability or death in affected patients. The aim of this study was to determine whether survival patterns differ between men and women with HIV/AIDS-related neurologic disease (neuro-AIDS).
  
  
  METHODS
  Retrospective cohort data from a statewide surveillance database for HIV/AIDS were used to characterize survival following an HIV/AIDS-related neurologic diagnosis for men and women with one or more of the following conditions: cryptococcosis, toxoplasmosis, primary central nervous system lymphoma, progressive multifocal leukoencephalopathy, and HIV-associated dementia. A second, non-independent cohort was formed using university-based cases to confirm and extend the findings from the statewide data. Kaplan-Meier analysis was used to compare the survival experiences for men and women in the cohorts. Cox regression was employed to characterize survival while controlling for potential confounders in the study population.
  
  
  RESULTS
  Women (n=27) had significantly poorer outcomes than men (n=198) in the statewide cohort (adjusted hazard ratio=2.31, 95% CI: 1.22 to 4.35), and a similar, non-significant trend was observed among university-based cases (n=17 women, 154 men). Secondary analyses suggested that this difference persisted over the course of the AIDS epidemic and was not attributable to differential antiretroviral therapy responses among men and women.
  
  
  CONCLUSIONS
  The survival disadvantage of women compared to men should be confirmed and the mechanisms underlying this disparity elucidated. If this relationship is confirmed, targeted clinical and public health efforts might be directed towards screening, treatment, and support for women affected by neuro-AIDS.
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, Iowa, United States of America; The Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, United States of America; The Medical Scientist Training Program, The University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Carvour
authors.affiliation: Bureau of Human Immunodeficiency Virus, Sexually Transmitted Diseases, and Hepatitis, Iowa Department of Public Health, Des Moines, Iowa, United States of America.
authors.forename: Jerald P
authors.initials: JP
authors.lastname: Harms
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Lynch
authors.affiliation: Bureau of Human Immunodeficiency Virus, Sexually Transmitted Diseases, and Hepatitis, Iowa Department of Public Health, Des Moines, Iowa, United States of America.
authors.forename: Randall R
authors.initials: RR
authors.lastname: Mayer
authors.affiliation: Department of Internal Medicine, The University of Iowa, Iowa City, Iowa, United States of America; Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, United States of America.
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Meier
authors.affiliation: Department of Psychiatry, The University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: Dawei
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, Iowa, United States of America; The Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, United States of America.
authors.forename: James C
authors.initials: JC
authors.lastname: Torner
mesh_terms: D000328:Adult; D003863:Depression / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D006678:HIV / Q000472:pathogenicity; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000821:virology; D012307:Risk Factors; D012727:Sex Characteristics