To evaluate sex differences in human immunodeficiency virus (HIV)
disease progression before (pre-1997) and after (1997-2006) introduction of
highly active antiretroviral therapy, the authors used data from a collaboration of 23 HIV seroconverter cohort studies from Europe, Australia, and Canada restricted to the 6,923 seroconverters infected through injecting
drug use and sex between men and women. Within a competing risk framework, they used Cox proportional hazards models allowing for late entry to evaluate sex differences in time from
HIV seroconversion to death, to
acquired immunodeficiency syndrome (
AIDS), and to each
first AIDS-defining disease and death without
AIDS. While no significant sex differences were found before 1997, from 1997 onward, women had a lower risk of
AIDS (adjusted cumulative relative risk (aCRR) = 0.76, 95% confidence interval (CI): 0.63, 0.90) and death (adjusted hazard ratio = 0.68, 95% CI: 0.56, 0.82) than men did. Compared with men, women also had lower risks of
AIDS dementia complex (aCRR = 0.23, 95% CI: 0.07, 0.74),
tuberculosis (aCRR = 0.60, 95% CI: 0.39, 0.92),
Kaposi's sarcoma (aCRR = 0.27, 95% CI: 0.07, 0.99),
lymphomas (aCRR = 0.47, 95% CI: 0.23, 0.96), and death without
AIDS (aCRR = 0.74, 95% CI: 0.56, 0.98). Sex differences in HIV
disease progression have become larger and statistically significant in the era of
highly active antiretroviral therapy, supporting a stronger impact of health interventions among women.