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Causes of Death in HIV-infected Women and Their Evolution Since 2000: The Mortalité 2000 and 2005 Surveys, ANRS EN19
Mojgan Hessamfar-Bonarek*1,2, G Chene1,2,3, P Cacoub4,5, D Salmon6, T May7, E Rosenthal8, C Lewden1,3, D Costagliola9, P Morlat1,2,3, and Mortalité 2000 & 2005 Study Group
1INSERM U593, Bordeaux, France.; 2Ctr Hosp Univ Bordeaux, France; 3Univ Bordeaux, France; 4Hosp Pitie-Salpetriere, Paris, France; 5Univ Pierre and Marie Curie, Paris, France; 6Ctr Hosp Univ Cochin-Tarnier, Paris, France; 7Ctr Hosp Nancy, France; 8Ctr Hosp Univ Nice, France; and 9INSERM U720, Paris, France
Background: Detailed analyses of the causes of death in HIV-infected women have
rarely been reported. This sub-study of the Mortality 2005 and 2000 surveys
aimed at describing women specificities at death as compared to men.
Methods: All
deaths occurring in HIV-infected adults were notified through years 2000 and
2005 in national surveys. A standardized questionnaire collected social,
demographic, clinical, biological, and therapeutic characteristics.
Results: Of
the 1013 HIV-infected adults dead in 2005, 247 (24%) were women (22% in 2000); 32%
of women were infected through injecting drug use (30% in men) and 53% through
heterosexual intercourse (25% in men). In 2005, the proportion of AIDS-related
diseases was higher in women than in men (43% vs 34%, p = 0.01), whereas
it did not differ in 2000 (47%). In women, age at death was lower (43 vs 46
years, p <0.001), Sub-Saharan African origin was more frequent (27%
vs 9%, p <0.001 ), as was socioeconomic precariousness (38% vs 28%, p
= 0.006), conversely to tobacco use (47% vs 59%, p = 0.002),
excessive alcohol consumption (22% vs 31%, p = 0.008), and dyslipidemia
(4% vs 10%, p = 0.01). Although not statistically significant, deceased
women seemed to be less frequently exposed to combination ART (77% vs 82%), and
to have lower latest CD4 count (137 vs 167/mm3). The 3 more frequent
AIDS-related causes of death in 2005 were, non-Hodgkin's lymphoma (19% vs 21%
in 2000), multifocal leukoencephalopathy (18% vs 3%),.and cerebral
toxoplasmosis (14% vs 17%). Regarding non-AIDS-related causes of death in 2005,
women died less frequently than men from respiratory malignancies (lung,
ear/nose/throat) and cardiovascular diseases (9% of all causes of death vs 16%;
p = 0.004), and suicides or accidents (4% vs 9%, p = 0.02).
Breast cancer was a cause of death in 3% and cervical cancer in 2% of women.
Conclusions: In a context of global decrease since 2000, AIDS-related
deaths are nowadays more frequent in women than in men. Even in a setting of
universal access to care, HIV-infected women, especially migrants in poor
socioeconomic conditions, may not benefit from optimal case management.
Conversely, the lower proportion of non-AIDS causes of deaths observed in women
may be explained by a lower prevalence of traditional risk factors of
respiratory or cardiovascular diseases and of violent deaths.
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