How do outcomes compare between women and men living with HIV in Australia? An observational study

Abstract

Background Gender differences vary across geographical settings and are poorly reported in the literature. The aim of this study was to evaluate demographics and clinical characteristics of participants from the Australian HIV Observational Database (AHOD), and to explore any differences between females and males in the rate of new clinical outcomes, as well as initial immunological and virological response to antiretroviral therapy. Methods Time to a new clinical end-point, all-cause mortality and/or AIDS illness was analysed using standard survival methods. Univariate and covariate adjusted Cox proportional hazard models were used to evaluate the time to plasma viral load suppression in all patients that initiated antiretroviral therapy (ART) and time to switching from a first-line ART to a second-line ART regimen. Results There was no significant difference between females and males for the hazard of all-cause mortality [adjusted hazard ratio: 0.98 (0.51, 1.55), P = 0.67], new AIDS illness [adjusted hazard ratio: 0.75 (0.38, 1.48), P = 0.41] or a composite end-point [adjusted hazard ratio: 0.74 (0.45, 1.21), P = 0.23]. Incident rates of all-cause mortality were similar between females and males; 1.14 (0.61, 1.95) vs 1.28 (1.12, 1.45) per 100 person years. Virological response to ART was similar for females and males when measured as time to viral suppression and/or time to virological failure. Conclusion This study supports current Australian HIV clinical care as providing equivalent standards of care for male and female HIV-positive patients. Future studies should compare ART-associated toxicity differences between ART-associated toxicity differences between men and women living with HIV in Australia.

High mortality rates in men initiated on anti-retroviral treatment in KwaZulu-Natal, South Africa

“…Conversely, studies from developed countries show differing results, finding no gender differences in clinical, virological and immunological outcomes among HIV infected men and women initiating ART [ 22 , 23 ]. A multi-site cohort study found higher rates of virological rebound in women [ 7 ].…”

Sex‐based differences in antiretroviral therapy initiation, switching and treatment interruptions: global overview from the International Epidemiologic Databases to Evaluate AIDS (IeDEA)

“…Gender differences in toxicity have been reported for nucleoside analogues , NNRTIs and protease inhibitors (PI) , though clinical trials have not been able to definitively establish sex differences in toxicity risk. Clinical outcomes such as immunological response, new AIDS events, or death, have not been found to significantly differ by sex in either resource‐rich or ‐limited settings .…”

Gender difference in all‐cause mortality of people living with HIV in Iran: findings from a 20‐year cohort study

“…However, a few studies have suggested no difference between men and women in the response to ART [19–21]. For example, two studies in Australia [22] and Switzerland [23] reported no significant difference between men and women regarding viral load suppression. Given structural and cultural variation across settings, it is possible that the response to ART in men and women is different in less‐developed countries.…”