Factors associated with sex differences in viral non-suppression in the Swedish InfCareHIV cohort: An observational real-world study

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES HIV Medicine Pub Date : 2024-01-09 DOI:10.1111/hiv.13607

Maria Lindh, Johanna Brännström, Anton Reepalu, Veronica Svedhem, Åsa Mellgren

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Abstract

Objectives

Women living with HIV are underrepresented in clinical trials assessing outcomes of antiretroviral treatment (ART), justifying the need for observational studies. We investigated differences in viral non-suppression between women and men in the Swedish InfCareHIV cohort and analysed results in relation to biological and socio-demographic variables and patient-reported outcome measures (PROMs).

Methods

The study included people living with HIV (PLWH) aged ≥18 years, who initiated ART at least 6 months prior to inclusion. Data from the InfCareHIV registry 2011–2018 were collected. Associations between variables and HIV RNA ≥50 copies/mL were investigated in uni- and multivariable analyses using generalized estimating equations, providing relative risks (RRs) as effect size.

Results

The study included 38% (n = 2981) women. Women were more likely to have HIV RNA ≥50 copies/mL than were men [RR = 1.20, 95% confidence interval (CI): 1.10–1.31]. After adjusting for origin and route of transmission, sex at birth was no longer associated with viral non-suppression. PROMs were available in 52.4% of PLWH, and items associated with viral non-suppression were impaired adherence in women (RR = 2.38, 95% CI: 1.79–3.17) and men (RR 1.84, 95% CI: 1.40–2.42), and experience of side effects in women (RR = 1.49, 95% CI: 1.10–2.02).

Conclusions

This observational study found a 20% higher relative risk of viral non-suppression in women than in men and the difference was associated with socio-demographic factors. The associations between PROMs and viral non-suppression varied between women and men. PROMs are important health outcomes that may identify PLWH in need of support to achieve viral non-suppression.

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瑞典 InfCareHIV 队列中与病毒不抑制性别差异相关的因素：一项观察性真实世界研究。

目的：在评估抗逆转录病毒疗法（ART）疗效的临床试验中，女性艾滋病感染者所占比例较低，因此有必要开展观察性研究。我们调查了瑞典 InfCareHIV 队列中女性和男性在病毒未抑制方面的差异，并分析了与生物和社会人口学变量及患者报告结果测量指标（PROMs）相关的结果：研究对象包括年龄≥18 岁、至少在纳入前 6 个月开始接受抗逆转录病毒疗法的 HIV 感染者（PLWH）。研究收集了2011-2018年InfCareHIV登记数据。使用广义估计方程进行单变量和多变量分析，研究变量与HIV RNA ≥50 copies/mL之间的关系，提供相对风险（RR）作为效应大小：研究中女性占 38%（n = 2981）。与男性相比，女性感染 HIV RNA≥50 copies/mL 的几率更高[RR = 1.20，95% 置信区间 (CI)：1.10-1.31]。在对来源和传播途径进行调整后，出生时的性别与病毒未抑制不再相关。52.4%的 PLWH 可以提供 PROMs，与病毒抑制相关的项目包括女性（RR = 2.38，95% CI：1.79-3.17）和男性（RR 1.84，95% CI：1.40-2.42）的依从性受损，以及女性（RR = 1.49，95% CI：1.10-2.02）的副作用体验：这项观察性研究发现，女性病毒不抑制的相对风险比男性高 20%，而这种差异与社会人口因素有关。女性和男性的 PROMs 与病毒不耐受之间的关系各不相同。PROMs是重要的健康结果，可识别出需要支持以实现病毒无抑制的 PLWH。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.