How do outcomes compare between women and men living with HIV in Australia? An observational study
Michelle L. Giles A B I , Marin C. Zapata C , Stephen T. Wright D E , Kathy Petoumenos D , Miriam Grotowski F , Jennifer Broom G , Matthew G. Law D and Catherine C. O’Connor C D HA Department of Infectious Diseases, Monash University, Clayton, Vic. 3168, Australia.
B Monash Infectious Diseases, Monash Health, Clayton, Vic. 3168, Australia.
C RPA Sexual Health, Sydney Local Health District, Sydney, NSW 2050, Australia.
D The Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia.
E School of Mathematical and Physical Sciences, University of Technology, Sydney, NSW 2007, Australia.
F Tamworth Sexual Health Service, Tamworth, NSW 2340, Australia.
G Department of Medicine, Nambour Hospital, Nambour, Qld 4560, Australia.
H Central Clinical School, University of Sydney, Sydney, NSW 2052, Australia.
I Corresponding author. Email: m.giles@alfred.org.au
Sexual Health 13(2) 155-161 https://doi.org/10.1071/SH15124
Submitted: 7 July 2015 Accepted: 24 November 2015 Published: 1 February 2016
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.
Additional keywords: AIDS, gender, treatment.
References
[1] The Kirby Institute. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2013. The University of New South Wales, Sydney: The Kirby Institute; 2013. Available online at: http://www.kirby.unsw.edu.au [verified 18 June 2015].[2] Johnston R, Curno MJ, Etya-ale H, Hodges-Mameletzis I, Price M, Rossi S, et al. Female participation in HIV Studies. 7th IAS Conference on HIV Pathogenesis treatment and prevention; 30 June–3 July 2013; Kuala Lumpur, Malaysia.
[3] Westreich D, Rosenberg M, Schwartz S, Swamy G. Representation of women and pregnant women in HIV research: a limited systematic review. PLoS One 2013; 8 e73398
| Representation of women and pregnant women in HIV research: a limited systematic review.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhtl2iu7bI&md5=20b10472fb7836777cefe65c3e1da123CAS | 24009750PubMed |
[4] Soon GG, Min M, Struble KA, Chan-Tack KM, Hammerstrom T, Qi K, et al Meta-analysis of gender differences in efficacy outcomes for HIV-positive subjects in randomized controlled clinical trials of antiretroviral therapy (2000–2008) AIDS Patient Care STDS 2012; 26 444–53.
| Meta-analysis of gender differences in efficacy outcomes for HIV-positive subjects in randomized controlled clinical trials of antiretroviral therapy (2000–2008)Crossref | GoogleScholarGoogle Scholar | 22734949PubMed |
[5] Currier J, Averitt Bridge D, Hagins D, Zorrilla CD, Feinberg J, Ryan R, Falcon R, Tennenberg A, Mrus J, Squires K, GRACE (Gender, Race, And Clinical Experience) Study Group. Sex-based outcomes of darunavir–ritonavir therapy: a single-group trial. Ann Intern Med 2010; 153 349–57.
| Sex-based outcomes of darunavir–ritonavir therapy: a single-group trial.Crossref | GoogleScholarGoogle Scholar | 20855799PubMed |
[6] Squires KE, Johnson M, Yang R, Uy J, Sheppard L, Absalon J, McGrath D. Comparative gender analysis of the efficacy and safety of atazanavir/ritonavir and lopinavir/ritonavir at 96 weeks in the CASTLE study J Antimicrob Chemother 2011; 66 363–70.
| Comparative gender analysis of the efficacy and safety of atazanavir/ritonavir and lopinavir/ritonavir at 96 weeks in the CASTLE studyCrossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXnsFWqtQ%3D%3D&md5=1022861a35a7f19bc0d2942fe131c3d1CAS | 21148235PubMed |
[7] Smith DK, Gardner LI, Phelps R, Hamburger ME, Carpenter C, Klein RS, et al Mortality rates and causes of death in a cohort of HIV-infected and uninfected women, 1993–1999. J Urban Health 2003; 80 676–88.
| Mortality rates and causes of death in a cohort of HIV-infected and uninfected women, 1993–1999.Crossref | GoogleScholarGoogle Scholar | 14709715PubMed |
[8] Cohen MH, French AL, Benning L, Kovacs A, Anastos K, Young M, et al Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy. Am J Med 2002; 113 91–8.
| Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy.Crossref | GoogleScholarGoogle Scholar | 12133746PubMed |
[9] Kiertiburanakul S, Boettiger D, Lee MP, Omar SF, Tanuma J, Ng OT, Durier N, et al Trends of CD4 cell count levels at the initiation of antiretroviral therapy over time and factors associated with late initiation of antiretroviral therapy among Asian HIV-positive patients. J Int AIDS Soc 2014; 17 18804
| 24598459PubMed |
[10] Jarrin I, Geskus R, Bhaskaran K, Prins M, Perez-Hoyos S, Muga R, et al CASCADE Collaboration Gender differences in HIV progression to AIDS and death in industrialized countries: slower disease progression following HIV seroconversion in women. Am J Epidemiol 2008; 168 532–40.
| Gender differences in HIV progression to AIDS and death in industrialized countries: slower disease progression following HIV seroconversion in women.Crossref | GoogleScholarGoogle Scholar | 18663213PubMed |
[11] Kwakwa H, Spencer D, Evans C, Garner W, Walker I, Temme L. Gender difference in virologic outcomes in a meta-analysis of randomized controlled trials in HIV1-infected patients on antiretroviral therapy. XIX International AIDS conference; 22–27 July 2012; Washington DC, USA. Abstract THPE041.
[12] The Australian HIV Observational Database Rates of combination antiretroviral treatment change in Australia, 1997–2000. HIV Med 2002; 3 28–36.
| Rates of combination antiretroviral treatment change in Australia, 1997–2000.Crossref | GoogleScholarGoogle Scholar | 12059948PubMed |
[13] Emery J, Pick N, Mills EJ, Cooper CL. Gender differences in clinical, immunological and virological outcomes in highly active antiretroviral-treated HIV-HCV coinfected patients. Patient Prefer Adherence 2010; 4 97–103.
| 20517470PubMed |
[14] Wright S, Boyd MA, Yunihastuti E, Law M, Sirisanthana T, Hoy J, Pujari S, Lee MP, Petoumenos K, International Epidemiologic Databases to Evaluate AIDS (IeDEA) Asia-Pacific HIV Observational Database (APHOD). Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific region PLoS One 2013; 8 e64902
| Rates and factors associated with major modifications to first-line combination antiretroviral therapy: results from the Asia-Pacific regionCrossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXhtFahsrfL&md5=9e340245dbaca412283ef298a5ae10a8CAS | 23840312PubMed |
[15] Palombi L, Marazzi MC, Guidotti G, Germano P, Buonomo E, Scarcella P, Doro Altan A, Zimba Ida V, San Lio MM, De Luca A, DREAM Program Incidence and predictors of death, retention, and switch to second-line regimens in antiretroviral- treated patients in sub-Saharan African Sites with comprehensive monitoring availability. Clin Infect Dis 2009; 48 115–22.
| Incidence and predictors of death, retention, and switch to second-line regimens in antiretroviral- treated patients in sub-Saharan African Sites with comprehensive monitoring availability.Crossref | GoogleScholarGoogle Scholar | 20380075PubMed |
[16] Hull M, Cescon A, Raboud J, Klein MB, Walmsley S, Ding E, Shurgold S, et al. CANOC Collaboration. Switching from first antiretroviral therapy regimen while virologically suppressed is associated with increased risk of subsequent virologic failure. 20th International AIDS Conference 20–25 July 2014; Melbourne, Australia. Abstract TUAB0103.
[17] Mazhude C, Jones S, Murad S, Taylor C, Easterbrook PJ. Female sex but not ethnicity is a strong predictor of non-nucleoside reverse transcriptase inhibitor-induced rash. AIDS 2002; 16 1566–8.
| Female sex but not ethnicity is a strong predictor of non-nucleoside reverse transcriptase inhibitor-induced rash.Crossref | GoogleScholarGoogle Scholar | 12131201PubMed |
[18] Galli M, Ridolfo AL, Adorni F, Gervasoni C, Ravasio L, Corsico L, et al Body habitus changes and metabolic alterations in protease inhibitor naïve HIV-1-infected patients treated with two nucleoside reverse transcriptase inhibitors. J Acquir Immune Defic Syndr 2002; 29 21–31.
| Body habitus changes and metabolic alterations in protease inhibitor naïve HIV-1-infected patients treated with two nucleoside reverse transcriptase inhibitors.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD38Xht1yktbc%3D&md5=a400218e10f54127abc0586aeba5b668CAS | 11782586PubMed |
[19] Agarwal D, Chakravarty J, Chaube L, Rai M, Agrawal NR, Sundar S, et al High incidence of zidovudine induced anemia in HIV infected patients in eastern India. Indian J Med Res 2010; 132 386–9.
| 20966515PubMed |
[20] Bersoff-Matcha SJ, Miller WC, Aberg JA, van Der Horst C, Hamrick HJ, Powderly WG, et al Sex differences in nevirapine rash. Clin Infect Dis 2001; 32 124–9.
| Sex differences in nevirapine rash.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7jt1Kntg%3D%3D&md5=424630221387c5b9df836943bdca8b99CAS | 11118391PubMed |
[21] Spire B, Carrieri P, Garzot MA, L’henaff M, Obadia Y, TRT-5 Group Factors associated with efavirenz discontinuation in a large community-based sample of patients. AIDS Care 2004; 16 558–64.
| Factors associated with efavirenz discontinuation in a large community-based sample of patients.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2czmvFerug%3D%3D&md5=54dd2b1dd094a29022a87d3076b30fb1CAS | 15223524PubMed |
[22] UNAIDS/WHO. Ethical considerations for biomedical HIV prevention trials: guidance document; 2007. Available online at: http://data.unaids.org/pub/manual/2007/jc1349_ethics_2_11_07_en.pdf [verified 1 September 2014].
[23] Heidari S, Eckert MJ, Kippax S, Karim QA, Sow PS, Wainberg MA. Time for gender mainstreaming in editorial policies. J Int AIDS Soc 2011; 14 11
| Time for gender mainstreaming in editorial policies.Crossref | GoogleScholarGoogle Scholar | 21385405PubMed |
[24] Heidari S, Abdool Karim Q, Auerbach JD, Buitendijk SE, Cahn P, Curno MJ, et al Gender-sensitive reporting in medical research. J Int AIDS Soc 2012; 15 11
| Gender-sensitive reporting in medical research.Crossref | GoogleScholarGoogle Scholar | 22400977PubMed |
[25] Heidari S, Babor T. Science editors: evaluate gender equality in journals. Nature 2013; 495 47
| Science editors: evaluate gender equality in journals.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXjsFCntb0%3D&md5=ccda7c00c43efa44e133a8e45184c3beCAS | 23467161PubMed |
