Sex differences in overall and cause-specific mortality among HIV-infected adults on antiretroviral therapy in Europe, Canada and the US

Inma Jarrin*, Santiago Moreno, Sue Ingle, Margaret T May, Timothy R. Sterling, Amy Justice, Markus Bickel, Heidi Crane, Michael J. Mugavero, Frank De Wolf, Norma Jung, Angela Cescon, Isabel Garcia, Luigia Elzi, Antonella d'Arminio Monforte, Murielle Mary-Krause, Colette Smith, Jodie Guest, Mojgan Hessamfar, John GillJonathan A C Sterne, Julia Del Amo

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

21 Citations (Scopus)
1233 Downloads (Pure)


Background: Here, we aimed to evaluate regional differences in all-cause, AIDS- and non-AIDS-related mortality in HIV-positive men and women started on combination antiretroviral therapy (cART) in Europe, Canada and the US. Methods: The ART Cohort Collaboration (ART-CC) combines 19 cohorts of individuals started on cART in Europe and North America (NA). We analysed patients infected via injecting drug use (IDU) or heterosexual sex using Cox proportional hazards models. Results: A total of 32,443 European (45.9% women), 1,162 (32.5% women) Canadian and 2,721 (15.5% women) US patients were included. In Europe and NA, women were younger, more likely to have acquired HIV heterosexually, be AIDS-free and have higher CD4<sup>+</sup> T-cell counts and lower HIV-1 RNA at baseline. European women had lower rates of all-cause (adjusted hazard ratio: 0.76; 95% CI 0.68, 0.84) and non-AIDS mortality (0.67; 0.57, 0.78) than men, but AIDS-mortality rates were similar (0.90; 0.75, 1.09). Women had lower mortality due to non-AIDS infections (0.6 versus 1.3 per 1,000 person-years), liver diseases (0.4 versus 1.7), non-AIDS malignancies (0.6 versus 2.0) and cardiovascular diseases (0.6 versus 1.0). Between-sex differences in all-cause mortality were larger in heterosexuals (0.70; 0.61, 0.80) than in IDU (0.88; 0.73, 1.05; interaction P-value =0.043). No sex differences in all-cause mortality were found in Canada (hazard ratio women 1.13; 0.82, 1.56) or US (hazard ratio women 1.12; 0.79, 1.58). Conclusions: The increasing importance of non-AIDS mortality is leading to emergent sex differences among HIV-positive patients in Europe, as in the general population. Despite the better clinical characteristics at cART initiation, women in NA had similar mortality to men.

Original languageEnglish
Pages (from-to)21-28
Number of pages8
JournalAntiviral Therapy
Issue number1
Early online date27 Mar 2014
Publication statusPublished - 1 Jan 2015

Bibliographical note

Date of Acceptance: 08/03/2014


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