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Severe morbidity according to sex in the era of combined antiretroviral therapy: the ANRS CO3 Aquitaine Cohort.

Hessamfar M, Colin C, Bruyand M, Decoin M, Bonnet F, Mercié P, Neau D, Cazanave C, Pellegrin JL, Dabis F, Morlat P, Chêne G, GECSA study gro - PLoS ONE (2014)

Bottom Line: Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations.Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME.Women should be targeted to benefit cardiovascular prevention policies as well as men.

View Article: PubMed Central - PubMed

Affiliation: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France.

ABSTRACT

Objective: To describe trends and determinants of severe morbidity in HIV-infected women and men.

Design: A French prospective cohort of HIV-infected patients of both sexes and all transmission categories.

Methods: We used hospital admission data from January 2000 to December 2008. A severe morbid event (SME) was defined as a clinical event requiring hospitalization for ≥48 h, several events could be reported during hospitalization. Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations.

Results: Among 4,987 patients (27% women), followed for a median of 8.7 years, 1,473 (30%) were hospitalized (3,049 hospitalizations for 5,963 SME). The yearly incidence rate of hospitalization decreased in men, from 155 in 2000 to 80/1,000 person-years (PY) in 2008 and in women, from 125 to 71/1,000 PY, (p<0.001). This trend was observed for all SME except for hepatic events, stable in men (15 to 13/1,000 PY) and increasing in women (2.5 to 11.5), cardiovascular events increasing in men (6 to 10/1,000 PY) and in women (6 to 14) and non-AIDS non-hepatic malignancies increasing in men (4 to 7/1,000 PY) and stable in women (2.5). Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME.

Conclusions: HIV-infected individuals in care in France require less and less frequently hospitalization. Women are now presenting with severe hepatic and cardio-vascular events. Disparities in SME between men and women are primarily explained by different exposure patterns to risk factors. Women should be targeted to benefit cardiovascular prevention policies as well as men.

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Incidence rates of severe morbid events according to sex (ANRS CO3 Aquitaine Cohort 2000–2008).p1 : Poisson regression test for trend, p2 : Year*sex interaction test. Fig. 3a. AIDS events, p1<0.001, p2<0.001. Fig. 3b. Bacterial infections, p1<0.01, p2 = 0.99. Fig. 3c. Psychiatric events, p1 = 0.25, p2<0.005. Fig. 3d. Hepatic events, p1 = 0.18, p2 = 0.48. Fig. 3e. Cardiovascular events, p1 = 0.25, p2 = 0.83. Fig. 3f. Non-AIDS, non-hepatic malignancies, p1 =  0.18, p2<0.002.
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pone-0102671-g003: Incidence rates of severe morbid events according to sex (ANRS CO3 Aquitaine Cohort 2000–2008).p1 : Poisson regression test for trend, p2 : Year*sex interaction test. Fig. 3a. AIDS events, p1<0.001, p2<0.001. Fig. 3b. Bacterial infections, p1<0.01, p2 = 0.99. Fig. 3c. Psychiatric events, p1 = 0.25, p2<0.005. Fig. 3d. Hepatic events, p1 = 0.18, p2 = 0.48. Fig. 3e. Cardiovascular events, p1 = 0.25, p2 = 0.83. Fig. 3f. Non-AIDS, non-hepatic malignancies, p1 =  0.18, p2<0.002.

Mentions: Yearly incidence rates of the most frequent severe morbid events are represented globally and according to sex (Figure 3). AIDS events significantly decreased over calendar years in men and women, from 47 per 1000 PY in 2000 to 20 per 1000 PY in 2008 (p<0.001). Among non-AIDS defining events, bacterial infections also significantly decreased from 39 in 2000 to 21 per 1000 PY in 2008 (p<0.01), though becoming the first cause of hospitalization in 2008 for men and the third cause for women. Cardiovascular events globally increased from 6 to 13 per 1000 PY. This trend was more important in women (6 to 14/1000 PY) than in men (6 to 10/1000 PY). Other events did not significantly progress through years although the trends within sexes were different: hepatic events were stable in men (15 to 13/1000 PY) and increased in women (2.5 to 11.5/1000 PY), and non-AIDS non-hepatic malignancies increased in men (4 to 7/1000 PY) and remained stable in women (2.5/1000 PY) (Figure 2).


Severe morbidity according to sex in the era of combined antiretroviral therapy: the ANRS CO3 Aquitaine Cohort.

Hessamfar M, Colin C, Bruyand M, Decoin M, Bonnet F, Mercié P, Neau D, Cazanave C, Pellegrin JL, Dabis F, Morlat P, Chêne G, GECSA study gro - PLoS ONE (2014)

Incidence rates of severe morbid events according to sex (ANRS CO3 Aquitaine Cohort 2000–2008).p1 : Poisson regression test for trend, p2 : Year*sex interaction test. Fig. 3a. AIDS events, p1<0.001, p2<0.001. Fig. 3b. Bacterial infections, p1<0.01, p2 = 0.99. Fig. 3c. Psychiatric events, p1 = 0.25, p2<0.005. Fig. 3d. Hepatic events, p1 = 0.18, p2 = 0.48. Fig. 3e. Cardiovascular events, p1 = 0.25, p2 = 0.83. Fig. 3f. Non-AIDS, non-hepatic malignancies, p1 =  0.18, p2<0.002.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4116171&req=5

pone-0102671-g003: Incidence rates of severe morbid events according to sex (ANRS CO3 Aquitaine Cohort 2000–2008).p1 : Poisson regression test for trend, p2 : Year*sex interaction test. Fig. 3a. AIDS events, p1<0.001, p2<0.001. Fig. 3b. Bacterial infections, p1<0.01, p2 = 0.99. Fig. 3c. Psychiatric events, p1 = 0.25, p2<0.005. Fig. 3d. Hepatic events, p1 = 0.18, p2 = 0.48. Fig. 3e. Cardiovascular events, p1 = 0.25, p2 = 0.83. Fig. 3f. Non-AIDS, non-hepatic malignancies, p1 =  0.18, p2<0.002.
Mentions: Yearly incidence rates of the most frequent severe morbid events are represented globally and according to sex (Figure 3). AIDS events significantly decreased over calendar years in men and women, from 47 per 1000 PY in 2000 to 20 per 1000 PY in 2008 (p<0.001). Among non-AIDS defining events, bacterial infections also significantly decreased from 39 in 2000 to 21 per 1000 PY in 2008 (p<0.01), though becoming the first cause of hospitalization in 2008 for men and the third cause for women. Cardiovascular events globally increased from 6 to 13 per 1000 PY. This trend was more important in women (6 to 14/1000 PY) than in men (6 to 10/1000 PY). Other events did not significantly progress through years although the trends within sexes were different: hepatic events were stable in men (15 to 13/1000 PY) and increased in women (2.5 to 11.5/1000 PY), and non-AIDS non-hepatic malignancies increased in men (4 to 7/1000 PY) and remained stable in women (2.5/1000 PY) (Figure 2).

Bottom Line: Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations.Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME.Women should be targeted to benefit cardiovascular prevention policies as well as men.

View Article: PubMed Central - PubMed

Affiliation: INSERM U897 & CIC-EC7, Université de Bordeaux, Institut de Santé Publique Epidémiologie et Développement (ISPED), Bordeaux, France; Centre Hospitalier Universitaire (CHU) Bordeaux, Coordination Régionale de la lutte contre l'infection à VIH (COREVIH) Aquitaine, Bordeaux, France; CHU Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France.

ABSTRACT

Objective: To describe trends and determinants of severe morbidity in HIV-infected women and men.

Design: A French prospective cohort of HIV-infected patients of both sexes and all transmission categories.

Methods: We used hospital admission data from January 2000 to December 2008. A severe morbid event (SME) was defined as a clinical event requiring hospitalization for ≥48 h, several events could be reported during hospitalization. Yearly incidence rates of SME were estimated and compared using Generalized Estimating Equations.

Results: Among 4,987 patients (27% women), followed for a median of 8.7 years, 1,473 (30%) were hospitalized (3,049 hospitalizations for 5,963 SME). The yearly incidence rate of hospitalization decreased in men, from 155 in 2000 to 80/1,000 person-years (PY) in 2008 and in women, from 125 to 71/1,000 PY, (p<0.001). This trend was observed for all SME except for hepatic events, stable in men (15 to 13/1,000 PY) and increasing in women (2.5 to 11.5), cardiovascular events increasing in men (6 to 10/1,000 PY) and in women (6 to 14) and non-AIDS non-hepatic malignancies increasing in men (4 to 7/1,000 PY) and stable in women (2.5). Intraveneous drug users, age >50 years, HIV RNA >10,000 copies, CD4 <500/mm3, AIDS stage, hepatitis C co-infection and cardiovascular risk factors (diabetes, high blood pressure, and tobacco use) were associated with SME.

Conclusions: HIV-infected individuals in care in France require less and less frequently hospitalization. Women are now presenting with severe hepatic and cardio-vascular events. Disparities in SME between men and women are primarily explained by different exposure patterns to risk factors. Women should be targeted to benefit cardiovascular prevention policies as well as men.

Show MeSH
Related in: MedlinePlus