Differential Survival for Men and Women with HIV/AIDS-Related Neurologic Diagnoses.

ObjectivesNeurologic complications of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) frequently lead to disability or death in affected patients. The aim of this study was to determine whether survival patterns differ between men and women with HIV/AIDS-related neurologic disease (neuro-AIDS).MethodsRetrospective cohort data from a statewide surveillance database for HIV/AIDS were used to characterize survival following an HIV/AIDS-related neurologic diagnosis for men and women with one or more of the following conditions: cryptococcosis, toxoplasmosis, primary central nervous system lymphoma, progressive multifocal leukoencephalopathy, and HIV-associated dementia. A second, non-independent cohort was formed using university-based cases to confirm and extend the findings from the statewide data. Kaplan-Meier analysis was used to compare the survival experiences for men and women in the cohorts. Cox regression was employed to characterize survival while controlling for potential confounders in the study population.ResultsWomen (n=27) had significantly poorer outcomes than men (n=198) in the statewide cohort (adjusted hazard ratio=2.31, 95% CI: 1.22 to 4.35), and a similar, non-significant trend was observed among university-based cases (n=17 women, 154 men). Secondary analyses suggested that this difference persisted over the course of the AIDS epidemic and was not attributable to differential antiretroviral therapy responses among men and women.ConclusionsThe survival disadvantage of women compared to men should be confirmed and the mechanisms underlying this disparity elucidated. If this relationship is confirmed, targeted clinical and public health efforts might be directed towards screening, treatment, and support for women affected by neuro-AIDS

Interaction of birth sex and county type (n = 225).

<p>*Hazard ratio (HR) with 95% confidence interval (CI), adjusted for ART by treatment era interaction, age, race, birth sex, healthcare facility type, opportunistic infection count, HIV transmission risk category, and neuro-AIDS condition and stratifying on years since AIDS diagnosis and timing of neuro-AIDS.</p><p>**p = 0.0007.</p><p>Note: County at AIDS diagnosis was derived from urban influence codes. “Other area” denotes any county not designated by urban influence codes as a small metropolitan area.</p><p>Interaction of birth sex and county type (n = 225).</p

Kaplan-Meier curves for statewide cohort, stratified by birth sex.

<p>Kaplan-Meier curves for statewide cohort, stratified by birth sex.</p

Comparison of measures of disease severity by birth sex.

<p>Comparison of measures of disease severity by birth sex.</p

Characteristics of men and women in the statewide cohort.

<p>SD = Standard deviation.</p><p>*County at AIDS diagnosis with county type derived from urban influence codes.</p><p>MSM = Male sexual contact with male, IDU = Injection drug use, “Other” includes adult heterosexual contact; HMO = Health maintenance organization; OIs = Opportunistic infections.</p><p>**Excludes <i>Pneumocystis</i> pneumonia (PCP).</p><p>⁺Diagnosis prior to 1996.</p><p>Characteristics of men and women in the statewide cohort.</p