Gender inequalities in the response to combination antiretroviral therapy over time: the Swiss HIV Cohort Study

Rosin, C; Elzi, L; Thurnheer Zürcher, Maria Christine; Fehr, J; Cavassini, M; Calmy, A; Schmid, P; Bernasconi, E; Battegay, M (2015). Gender inequalities in the response to combination antiretroviral therapy over time: the Swiss HIV Cohort Study. HIV medicine, 16(5), pp. 319-325. Blackwell Science 10.1111/hiv.12203

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OBJECTIVES

Gender-specific data on the outcome of combination antiretroviral therapy (cART) are a subject of controversy. We aimed to compare treatment responses between genders in a setting of equal access to cART over a 14-year period.

METHODS

Analyses included treatment-naïve participants in the Swiss HIV Cohort Study starting cART between 1998 and 2011 and were restricted to patients infected by heterosexual contacts or injecting drug use, excluding men who have sex with men.

RESULTS

A total of 3925 patients (1984 men and 1941 women) were included in the analysis. Women were younger and had higher CD4 cell counts and lower HIV RNA at baseline than men. Women were less likely to achieve virological suppression < 50 HIV-1 RNA copies/mL at 1 year (75.2% versus 78.1% of men; P = 0.029) and at 2 years (77.5% versus 81.1%, respectively; P = 0.008), whereas no difference between sexes was observed at 5 years (81.3% versus 80.5%, respectively; P = 0.635). The probability of virological suppression increased in both genders over time (test for trend, P < 0.001). The median increase in CD4 cell count at 1, 2 and 5 years was generally higher in women during the whole study period, but it gradually improved over time in both sexes (P < 0.001). Women also were more likely to switch or stop treatment during the first year of cART, and stops were only partly driven by pregnancy. In multivariate analysis, after adjustment for sociodemographic factors, HIV-related factors, cART and calendar period, female gender was no longer associated with lower odds of virological suppression.

CONCLUSIONS

Gender inequalities in the response to cART are mainly explained by the different prevalence of socioeconomic characteristics in women compared with men.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Thurnheer Zürcher, Maria Christine

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1464-2662

Publisher:

Blackwell Science

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

30 Jul 2015 10:12

Last Modified:

19 Oct 2015 11:06

Publisher DOI:

10.1111/hiv.12203

PubMed ID:

25329751

Additional Information:

This work has been presented in part at the 13th European AIDS Conference (EACS), 12-15 October 2011, Belgrade, Serbia.

Uncontrolled Keywords:

HIV/AIDS; gender differences; women; antiretroviral therapy; outcome

BORIS DOI:

10.7892/boris.70586

URI:

https://boris.unibe.ch/id/eprint/70586

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