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Changes over Time in the Risk of AIDS by Sex: Slower Progression in Women in Recent Periods
Inmaculada Jarrin*1, J Del Amo1, K Bhaskaran2, S Perez-hoyos3, I Hernandez-aguado1, L Meyer4, M Prins5, K Porter2, and CASCADE Collaboration
1Univ Miguel Hernández, Alicante, Spain; 2Med Res Council Clin Trials Unit, London, UK; 3Escuela Valenciana de Estudios en Salud, Spain; 4Hosp Bicetre, France; and 5Municipal Hlth Svc, Amsterdam, The Netherlands
Background: Our aim was to evaluate the effect of sex on
the risk of developing AIDS (overall) and on each specific AIDS-defining
disease or dying without AIDS and to investigate changes over calendar period.
Methods: CASCADE data
restricted to seroconverters infected through injecting drug use (IDU) and
heterosexual intercourse were analyzed. The effect of sex on overall
progression to AIDS was investigated using Kaplan-Meier curves and Cox
proportional hazard models allowing for late-entry, and adjusted for age at
seroconversion, exposure category, and calendar period (pre-1997, 1997-1998,
1999-2004). The risk of specific AIDS-defining diseases was assessed through
competing risks analyses adjusting for the same factors.
Results: Of 3642
seroconverters, 57.2% were men, 65.4% IDU, 26.8% progressed to AIDS, and 9.6%
died without AIDS. Overall, women had a marginally lower risk of AIDS (0.91, 95%CI
0.79 to 1.05) compared to men. A borderline significant interaction between sex
and calendar period (p = 0.09) was
found. Before 1999, no difference in the risk of progression to AIDS was found
between men and women (0.99 95%CI, 0.84 to 1.16 and 0.87, 0.61 to 1.26 for
pre-1997 and 1997-1998, respectively; p
= 0.90 and 0.47). By 1999– 2004, women experienced a much lower hazard (0.66
95%CI, 0.48 to 0.92) despite apparently similar person-time spent on HAART as
men (54.4% and 52.9% in men and women, respectively). Although the risk of an
event was similar for most specific AIDS-defining diseases and death without an
AIDS diagnosis, women experienced statistically lower risks than men for HIV
encephalopathy (0.33, 0.16 to 0.67) and Kaposi’s sarcoma (0.19, 0.04 to 0.95).
A lower risk in women was also observed for tuberculosis (0.74, 0.48 to 1.12),
lymphomas (0.61, 0.25 to 1.47), and progressive multifocal leukencephalopathy
(0.75, 0.32 to 1.76) although the difference did not reach the statistical
significance. We found no evidence to suggest a change in the effect of sex
over time on progression to each AIDS-defining disease, but numbers were few.
Conclusions: There has been a trend toward an improved
outcome for HIV-infected women over time compared with their male counterparts,
which may be due to differences in health-seeking behavior and HAART uptake
between men and women.
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