1887
Research Open Access
Like 0

Abstract

Background

Epidemiological and immunovirological features of people living with HIV (PLWH) can vary by sex.

Aim

To investigate, particularly according to sex, characteristics of PLWH who consulted a tertiary hospital in Barcelona, Spain, in 1982–2020.

Methods

PLWH, still in active follow-up in 2020 were retrospectively analysed by sex, age at diagnosis, age at data extraction (December 2020), birth place, CD4+ cell counts, and virological failure.

Results

In total, 5,377 PLWH (comprising 828 women; 15%) were included. HIV diagnoses in women appeared to decrease from the 1990s, representing 7.4% (61/828) of new diagnoses in 2015–2020. From 1997, proportions of new HIV diagnoses from patients born in Latin America seemed to increase; moreover, for women born outside of Spain, the median age at diagnosis appeared to become younger than for those born in Spain, with significant differences observed in 2005–2009 and 2010–2014 (31 vs 39 years (p = 0.001), and 32 vs 42 years (p < 0.001) respectively), but not in 2015–2020 (35 vs 42 years; p = 0.254). Among women, proportions of late diagnoses (CD4+ cells/mm3 < 350) were higher than men (significantly in 2015–2020: 62% (32/52) vs 46% (300/656); p = 0.030). Initially, virological failure rates were higher in women than men, but they were similar in 2015–2020 (12% (6/52) vs 8% (55/659); p = 0.431). Women ≥ 50 years old represented 68% (564/828) of women actively followed up in 2020.

Conclusions

Women still have higher rates of late HIV diagnoses than men. Among currently-followed-up women, ≥ 50 year-olds, who need age-adapted care represent a high percentage. Stratifying PLWH by sex matters for HIV prevention and control interventions.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2023.28.10.2200317
2023-03-09
2024-06-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.10.2200317
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/28/10/eurosurv-28-10-3.html?itemId=/content/10.2807/1560-7917.ES.2023.28.10.2200317&mimeType=html&fmt=ahah

References

  1. UNAIDS. The Joint United Nations Programme on HIV and AIDS (UNAIDS). Global HIV&AIDS statistics. Fact sheet, 2022. [Accessed 28 Oct 2022]. Available from: https://www.unaids.org/en/resources/fact-sheet
  2. Scully EP. Sex Differences in HIV Infection. Curr HIV/AIDS Rep. 2018;15(2):136-46.  https://doi.org/10.1007/s11904-018-0383-2  PMID: 29504062 
  3. Bozzette SA, Berry SH, Duan N, Frankel MR, Leibowitz AA, Lefkowitz D, et al. , HIV Cost and Services Utilization Study Consortium. The care of HIV-infected adults in the United States. N Engl J Med. 1998;339(26):1897-904.  https://doi.org/10.1056/NEJM199812243392606  PMID: 9862946 
  4. Unidad de vigilancia de VIH, ITS y hepatitis. Vigilancia Epidemiológica del VIH y sida en España 2021: Sistema de Información sobre Nuevos Diagnósticos de VIH y Registro Nacional de Casos de Sida. [Epidemiological Surveillance of HIV and AIDS in Spain 2021: Information System on New HIV Diagnoses and National Registry of AIDS Cases]. Centro Nacional de Epidemiología. Instituto de Salud Carlos III/ División de control de VIH, ITS, Hepatitis virales y tuberculosis. Madrid: Ministerio de Sanidad; Nov 2022. Spanish.
  5. WHO Regional Office for Europe (WHO/Europe), European Centre for Disease Prevention and Control (ECDC). HIV/AIDS surveillance in Europe 2022 – 2021 data. Copenhagen: WHO Europe, Stockholm: ECDC; 2022.
  6. Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT). Vigilància epidemiològica del VIH i la SIDA a Catalunya. Informe anual 2020. [Epidemiological surveillance of HIV and AIDS in Catalonia. Annual report 2020]. Badalona; 2021. Catalan.
  7. Muñoz Hornero C, Muriel A, Montero M, Iribarren JA, Masía M, Muñoz L, et al. Differences in epidemiology and mortality between men and women with HIV infection in the CoRIS cohort from 2004 to 2014. Enferm Infecc Microbiol Clin (Engl Ed). 2021;39(8):372-82.  https://doi.org/10.1016/j.eimce.2021.07.003  PMID: 34373227 
  8. Kowalska JD, Aebi-Popp K, Loutfy M, Post FA, Perez-Elias MJ, Johnson M, et al. , Women Against Viruses in Europe (WAVE) Working Group. Promoting high standards of care for women living with HIV: position statement from the Women Against Viruses in Europe Working Group. HIV Med. 2018;19(2):167-73.  https://doi.org/10.1111/hiv.12565  PMID: 29159861 
  9. Hoyos J, Fernández-Balbuena S, de la Fuente L, Sordo L, Ruiz M, Barrio G, et al. , Madrid Rapid HIV Testing Group. Never tested for HIV in Latin-American migrants and Spaniards: prevalence and perceived barriers. J Int AIDS Soc. 2013;16(1):18560.  https://doi.org/10.7448/IAS.16.1.18560  PMID: 23663441 
  10. Instituto Nacional de Estadística (INE). INEbase. Encuesta de Fecundidad. Año 2018. Resultados definitivos. [INEbase. Fertility Survey. Year 2018. Final results]. 2018. Spanish.
  11. Instituto Nacional de Estadística (INE). INEbase: Principales series de población desde 1998. Población extranjera por nacionalidad, comunidades, sexo y año n.d. [INEbase: Main population series since 1998. Foreign population by nationality, communities, sex and year]. Spanish. [Accessed 28 Oct 2022]. Available from: https://www.ine.es/jaxi/Datos.htm?path=/t20/e245/p08/l0/&file=02005.px#!tabs-grafico.
  12. Reyes-Urueña J, Campbell C, Hernando C, Vives N, Folch C, Ferrer L, et al. Differences between migrants and Spanish-born population through the HIV care cascade, Catalonia: an analysis using multiple data sources. Epidemiol Infect. 2017;145(8):1670-81.  https://doi.org/10.1017/S0950268817000437  PMID: 28270252 
  13. Ayerdi Aguirrebengoa O, Vera Garcia M, Puerta López T, Clavo Escribano P, Ballesteros Martín J, Lejarrag Cañas C, et al. , Sandoval Study Group. Changes in the profile of newly HIV-diagnosed men who have sex with men, Madrid, 2014 to 2019. Euro Surveill. 2021;26(47):2001501.  https://doi.org/10.2807/1560-7917.ES.2021.26.47.2001501  PMID: 34823642 
  14. European Centre for Disease Prevention and Control (ECDC). HIV and migrants: Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia (2018 progress report). Stockholm: ECDC; 2019.
  15. European Centre for Disease Prevention and Control (ECDC). Public health guidance on HIV, hepatitis B and C testing in the EU/EEA: An integrated approach. Stockholm: 2018.
  16. Carnicer-Pont D, Vives N, Casabona I Barbarà J. Epidemiología de la infección por virus de la inmunodeficiencia humana. Retraso en el diagnóstico. [Epidemiology of human inmunodeficiency virus infection: delay in diagnosis]. Enferm Infecc Microbiol Clin. 2011;29(2):144-51.  https://doi.org/10.1016/j.eimc.2010.11.010  PMID: 21334780 
  17. Mårdh O, Quinten C, Kuchukhidze G, Seguy N, Dara M, Amato-Gauci AJ, et al. , ECDC/WHO HIV Surveillance network. HIV among women in the WHO European Region - epidemiological trends and predictors of late diagnosis, 2009-2018. Euro Surveill. 2019;24(48):1900696.  https://doi.org/10.2807/1560-7917.ES.2019.24.48.1900696  PMID: 31796153 
  18. Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, et al. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. Lancet Public Health. 2017;2(1):e35-46.  https://doi.org/10.1016/S2468-2667(16)30020-2  PMID: 29249478 
  19. Ang LW, Toh MPHS, Wong CS, Boudville IC, Archuleta S, Lee VJM, et al. Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016: Impact of late diagnosis of HIV infection. Medicine (Baltimore). 2021;100(26):e26507.  https://doi.org/10.1097/MD.0000000000026507  PMID: 34190180 
  20. World Health Organization (WHO). HIV/AIDS. Consolidated guidelines on HIV testing services 2019. Geneva: WHO. [Accessed 12 Nov 2019]. Available from: https://www.who.int/hiv/pub/ guidelines/hiv-testing-services/en/
  21. United Nations (UN). Resolution adopted by the General Assembly on 25 September 2015. 70/1. Transforming our world: the 2030 Agenda for Sustainable Development. A/RES/70/1 2015.
  22. Farzadegan H, Hoover DR, Astemborski J, Lyles CM, Margolick JB, Markham RB, et al. Sex differences in HIV-1 viral load and progression to AIDS. Lancet. 1998;352(9139):1510-4.  https://doi.org/10.1016/S0140-6736(98)02372-1  PMID: 9820299 
  23. Moore AL, Kirk O, Johnson AM, Katlama C, Blaxhult A, Dietrich M, et al. , EuroSIDA group. Virologic, immunologic, and clinical response to highly active antiretroviral therapy: the gender issue revisited. J Acquir Immune Defic Syndr. 2003;32(4):452-61.  https://doi.org/10.1097/00126334-200304010-00017  PMID: 12640206 
  24. Gandhi M, Bacchetti P, Miotti P, Quinn TC, Veronese F, Greenblatt RM. Does patient sex affect human immunodeficiency virus levels? Clin Infect Dis. 2002;35(3):313-22.  https://doi.org/10.1086/341249  PMID: 12115098 
  25. World Health Organization (WHO). Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy, July 2017. Geneva; 2017.
  26. Bhagwat P, Kapadia SN, Ribaudo HJ, Gulick RM, Currier JS. Racial Disparities in Virologic Failure and Tolerability During Firstline HIV Antiretroviral Therapy. Open Forum Infect Dis. 2019;6(2):ofz022.  https://doi.org/10.1093/ofid/ofz022  PMID: 30793009 
  27. Puskas CM, Forrest JI, Parashar S, Salters KA, Cescon AM, Kaida A, et al. Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep. 2011;8(4):277-87.  https://doi.org/10.1007/s11904-011-0098-0  PMID: 21989672 
  28. Kempf M-C, Pisu M, Dumcheva A, Westfall AO, Kilby JM, Saag MS. Gender differences in discontinuation of antiretroviral treatment regimens. J Acquir Immune Defic Syndr. 2009;52(3):336-41.  https://doi.org/10.1097/QAI.0b013e3181b628be  PMID: 19654551 
  29. 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(8):444-53.  https://doi.org/10.1089/apc.2011.0278  PMID: 22734949 
  30. Maiese EM, Johnson PT, Bancroft T, Goolsby Hunter A, Wu AW. Quality of life of HIV-infected patients who switch antiretroviral medication due to side effects or other reasons. Curr Med Res Opin. 2016;32(12):2039-46.  https://doi.org/10.1080/03007995.2016.1227776  PMID: 27552553 
  31. Mellgren Å, Eriksson LE, Reinius M, Marrone G, Svedhem V. Longitudinal trends and determinants of patient-reported side effects on ART-a Swedish national registry study. PLoS One. 2020;15(12):e0242710.  https://doi.org/10.1371/journal.pone.0242710  PMID: 33362248 
  32. Sax PE, Erlandson KM, Lake JE, Mccomsey GA, Orkin C, Esser S, et al. Weight Gain Following Initiation of Antiretroviral Therapy: Risk Factors in Randomized Comparative Clinical Trials. Clin Infect Dis. 2020;71(6):1379-89.  https://doi.org/10.1093/cid/ciz999  PMID: 31606734 
  33. Bakal DR, Coelho LE, Luz PM, Clark JL, De Boni RB, Cardoso SW, et al. Obesity following ART initiation is common and influenced by both traditional and HIV-/ART-specific risk factors. J Antimicrob Chemother. 2018;73(8):2177-85.  https://doi.org/10.1093/jac/dky145  PMID: 29722811 
  34. Yuh B, Tate J, Butt AA, Crothers K, Freiberg M, Leaf D, et al. Weight change after antiretroviral therapy and mortality. Clin Infect Dis. 2015;60(12):1852-9.  https://doi.org/10.1093/cid/civ192  PMID: 25761868 
/content/10.2807/1560-7917.ES.2023.28.10.2200317
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error