Impact of gender on the risk of AIDS-defining illnesses and mortality in Danish HIV-1-infected patients: A nationwide cohort study

Abstract

Background: Gender differences in the risk of AIDS-defining illness (ADI) and mortality have been reported in the HIV-1-infected (HIV-positive) population, with conflicting findings. We aimed to assess the impact of gender on the risk of ADI and death in HIV-positive patients infected sexually. Methods: This was a population-based, nationwide cohort study of incident Danish HIV-positive individuals infected by sexual contact. Outcomes were progression to AIDS and death. We used Cox proportional hazards models and Poisson regression analyses to calculate the risk of progression to AIDS and mortality rate ratios (MRR) between risk groups and compared these with the general Danish population. Results: We identified 587 heterosexually infected women, 583 men who have sex with women (MSW), and 1089 men who have sex with men (MSM). The total follow-up time was 13,708 person-y. At the time of HIV diagnosis MSM had a lower prevalence of AIDS compared to MSW. Women and MSW presented more often with tuberculosis and less often with AIDS-defining cancers compared to MSM. In the adjusted analyses we observed no differences in progression to AIDS. In the adjusted analyses of risk of death, there were no differences between the 3 risk groups, although we saw a trend towards a higher risk of death in older MSW. MSM had a lower risk of death compared to the background population than women and MSW. Conclusions: In the Danish HIV population, gender has no major impact on progression to AIDS or mortality. Differences in these factors between women, MSW, and MSM are mainly due to confounding from race and CD4 + cell count at diagnosis.

Keywords::

• HIV
• gender differences
• route of transmission
• AIDS-defining illnesses
• mortality

Acknowledgements

We thank the staff of our clinical departments at the participating centres in the Danish HIV Cohort Study for their continued support and enthusiasm: Department of Infectious Diseases at Copenhagen University Hospitals, Rigshospitalet (J. Gerstoft, N. Obel) and Hvidovre Hospital (G. Kronborg), Odense University Hospital (C. Pedersen), Aarhus University Hospitals, Skejby (C. S. Larsen), Aalborg University Hospital (G. Pedersen), Herning Hospital (A. L. Laursen), Helsingør Hospital (L. Nielsen), and Kolding Hospital (J. Jensen). The authors thank Preben and Anna Simonsen's Foundation, the AIDS Foundation, the NOVO Nordisk Foundation, and the Clinical Institute of Copenhagen University for financial support. No funding sources were involved in study design, data collection, analysis, report writing, or the decision to submit the paper.

Declaration of interest: KT has received honoraria from Janssen-Cilag and GlaxoSmithKline/Viiv; TLK has received research funding from Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline/Viiv, Abbott, Boehringer Ingelheim, Janssen-Cilag, and Swedish Orphan; NO has received research funding from Roche, Bristol-Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, Abbott, Boehringer Ingelheim, Janssen-Cilag, and Swedish Orphan; AML has received research funding from Abbott and honoraria from Bristol-Myers Squibb, Merck Sharp & Dohme, GlaxoSmithKline, Boehringer Ingelheim, and Janssen-Cilag. SL, SJF, MVL, IJ, GP, and MS report no conflicts of interest.