IJE Advance Access published online on October 5, 2009
International Journal of Epidemiology, doi:10.1093/ije/dyp300
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Causes of death in HIV-infected women: persistent role of AIDS. The ‘Mortalité 2000 & 2005’ Surveys (ANRS EN19)
1INSERM, U897, Bordeaux, France.
2Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire, Bordeaux, France.
3ISPED, Université Bordeaux 2, Bordeaux, France.
4Service de Médecine Interne, Centre Hospitalier Universitaire Cochin, Paris, France.
5AP-HP, Groupe Hospitalier Pitié-Salpétrière, Paris, France.
6IFRICI, Université Paris 6, CNRS, Paris, France.
7Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire, Nancy, France.
8Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire, Nice, France.
9INSERM, U943, Paris, France.
10UPMC, Université Paris 6, UMR S 720, Paris, France.
* Corresponding author. INSERM U897, Université Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France. E-mail: mojgan.bonarek{at}isped.u-bordeaux2.fr
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Abstract |
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Background Little is known about the causes of death in human immunodeficiency virus (HIV)-infected women in the era of combination antiretroviral therapy (ART).
Methods In the French nationwide Mortalité 2000 and 2005 surveys, physicians reported causes of deaths in HIV-infected adults in 2000 and 2005, using a standardized questionnaire. We used multivariate logistic regression models to study the association between gender and AIDS-defining causes of death, adjusting for other characteristics.
Results Of the 1013 HIV-infected adults who died in 2005, 247 (24%) were women. Half of women were infected through heterosexual contacts, compared with 25% men. In 2005, the proportion of AIDS-defining causes of death was higher in women than in men (43 vs 34%; P = 0.01), whereas it had been the same in 2000 (47% in women and men). In 2005, women died less frequently than men from respiratory malignancies (lung, ear/nose/throat) and cardiovascular disease (9% of all causes of death in women compared with 16% in men; P = 0.004), and suicides or accidents (4 vs 9%; P = 0.02). Socio-economic precariousness, younger age, less alcohol and tobacco consumption and lack of prior ART explained the higher proportion of deaths from AIDS in women compared with men.
Conclusions The higher proportion of AIDS-related deaths in women is probably explained by two factors: (i) some HIV-infected women, especially migrants in poor socio-economic conditions, may not have access to optimal care; and (ii) a lower prevalence of risk factors for respiratory, cardiovascular and violent deaths means that the risk of dying from non-AIDS causes may be lower in women.
Keywords AIDS, causes of death, HIV infection, women
List of participants of this study group is available in the Appendix. Accepted 5 August 2009
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