Abstract
BackgroundCohort data examining differences by gender in clinical responses to combination antiretroviral therapy (ART) remain inconsistent and have yet to be explored in a multi-province Canadian setting. This study investigates gender differences by injection drug use (IDU) history in virologic responses to ART and mortality.MethodsData from the Canadian Observational Cohort (CANOC) collaboration, a multisite cohort study of HIV-positive individuals initiating ART after January 1, 2000, were included. This analysis was restricted to participants with a follow-up HIV-RNA plasma viral load measure and known IDU history. Weibull hazard regression evaluated time to virologic suppression (2 consecutive measures <50 copies/mL), rebound (>1000 copies/mL after suppression), and all-cause mortality. Sensitivity analyses explored the impact of presumed ART use in pregnancy on virologic outcomes.ResultsAt baseline, women (1120 of 5442 participants) were younger (median 36 vs. 41 years) and more frequently reported IDU history (43.5% vs. 28.8%) (both p<0.001). Irrespective of IDU history, in adjusted multivariable analyses women were significantly less likely to virologically suppress after ART initiation and were at increased risk of viral load rebound. In adjusted time to death analysis, no differences by gender were noted. After adjusting for presumed ART use in pregnancy, observed gender differences in time to virologic suppression for non-IDU, and time to virologic rebound for IDU, became insignificant.ConclusionsHIV-positive women in CANOC are at heightened risk for poor clinical outcomes. Further understanding of the intersections between gender and other factors augmenting risk is needed to maximize the benefits of ART.
Highlights
Despite substantial reductions in morbidity and mortality since the introduction of combination antiretroviral therapy (ART), HIV and AIDS continue to be public health concerns in Canada [1]
This study investigates gender differences by injection drug use (IDU) history in virologic
In the total median follow-up time of 49 months (IQR 25–83), 462 deaths were reported and 548 participants were lost to follow-up
Summary
Despite substantial reductions in morbidity and mortality since the introduction of combination antiretroviral therapy (ART), HIV and AIDS continue to be public health concerns in Canada [1]. The profile of the HIV epidemic in Canada has changed, with a notable incidence escalation among women over the past 15 years [1,2]. Women have unique experiences of HIV infection and ART, which need to be further explored. Cohort data examining differences by gender in clinical responses to combination antiretroviral therapy (ART) remain inconsistent and have yet to be explored in a multi-province Canadian setting. This study investigates gender differences by injection drug use (IDU) history in virologic responses to ART and mortality
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