American Journal of Epidemiology Advance Access originally published online on July 28, 2008
American Journal of Epidemiology 2008 168(5):532-540; doi:10.1093/aje/kwn179
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ORIGINAL CONTRIBUTIONS |
Gender Differences in HIV Progression to AIDS and Death in Industrialized Countries: Slower Disease Progression Following HIV Seroconversion in Women
1 National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
2 Department of Public Health, Universidad Miguel Hernandez, Alicante, Spain
3 CIBER de Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain
4 Department of Research, Cluster of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
5 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
6 Clinical Trials Unit, Medical Research Council (MRC), London, United Kingdom
7 Center for Immunity and Infection Amsterdam (CINIMA), Academic Medical Center, Amsterdam, The Netherlands
8 Conselleria de Sanidad de la Comunidad Valenciana, Valencian School of Health Studies (EVES), Valencia, Spain
9 Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
10 Inserm, U822, Le Kremlin-Bicêtre, France
11 Faculté de Médecine Paris-Sud, Université Paris-Sud, Le Kremlin-Bicêtre, France
12 Assistance Publique - Hôpitaux de Paris, Hopital Bicêtre, Epidemiology and Public Health Service, Le Kremlin-Bicêtre, France
13 Department of Public Health, Universidad Rey Juan Carlos I, Madrid, Spain
Correspondence to Dr. Julia del Amo, National Center of Epidemiology, Instituto de Salud Carlos III, Sinesio Delgado 6 28029, Madrid, Spain (e-mail: jdamo{at}isciii.es).
Received for publication January 14, 2008. Accepted for publication May 28, 2008.
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.
acquired immunodeficiency syndrome; antiretroviral therapy, highly active; cohort studies; death; disease progression; HIV; sex
Abbreviations: aCRR, adjusted cumulative relative risk; AIDS, acquired immunodeficiency syndrome; CASCADE, Concerted Action on SeroConversion to AIDS and Death in Europe; CI, confidence interval; HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus