Severe morbidity according to sex in the era of combined antiretroviral therapy: the ANRS CO3 Aquitaine Cohort

Abstract

Objective: To describe trends and determinants of severe morbidity in HIV-infected women and men.

Design: A French prospective cohort of HIV-infected patients of both sexes and all transmission categories.

Methods: We used hospital admission data from January 2000 to December 2008. A severe morbid event (SME) was defined as a clinical event requiring hospitalization for ≥48 h, several events could be reported during hospitalization. Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations.

Results: Among 4,987 patients (27% women), followed for a median of 8.7 years, 1,473 (30%) were hospitalized (3,049 hospitalizations for 5,963 SME). The yearly incidence rate of hospitalization decreased in men, from 155 in 2000 to 80/1,000 person-years (PY) in 2008 and in women, from 125 to 71/1,000 PY, (p<0.001). This trend was observed for all SME except for hepatic events, stable in men (15 to 13/1,000 PY) and increasing in women (2.5 to 11.5), cardiovascular events increasing in men (6 to 10/1,000 PY) and in women (6 to 14) and non-AIDS non-hepatic malignancies increasing in men (4 to 7/1,000 PY) and stable in women (2.5). Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME.

Conclusions: HIV-infected individuals in care in France require less and less frequently hospitalization. Women are now presenting with severe hepatic and cardio-vascular events. Disparities in SME between men and women are primarily explained by different exposure patterns to risk factors. Women should be targeted to benefit cardiovascular prevention policies as well as men.

Figure 1. Evolution of yearly incidence rates of hospitalization according to sex (ANRS CO3 Aquitaine Cohort 2000–2008).

Figure 2. Distribution of severe morbid events according to sex.

Figure 3. Incidence rates of severe morbid events according to sex (ANRS CO3 Aquitaine Cohort 2000–2008).

p₁ : Poisson regression test for trend, p₂ : Year*sex interaction test. Fig. 3a. AIDS events, p₁<0.001, p₂<0.001. Fig. 3b. Bacterial infections, p₁<0.01, p₂ = 0.99. Fig. 3c. Psychiatric events, p₁ = 0.25, p₂<0.005. Fig. 3d. Hepatic events, p₁ = 0.18, p₂ = 0.48. Fig. 3e. Cardiovascular events, p₁ = 0.25, p₂ = 0.83. Fig. 3f. Non-AIDS, non-hepatic malignancies, p₁ =  0.18, p₂<0.002.