Background
We have previously shown lower life expectancy among females with HIV in British Columbia (BC), Canada, compared to males and an increasing sex gap in life expectancy from 1996 to 2020 (CROI 2024, Abstract #1053). To better understand the underlying drivers for this finding, we aimed to establish whether female sex is associated with higher mortality from two broad categories of non-communicable disease: (1) cardiovascular disease (CVD) and non-AIDS defining cancer (NADC), and (2) liver, renal, and chronic respiratory disease.
Methods
We used clinical and administrative health data from a population-based cohort study that included virtually all people with HIV in BC. We assessed cause-specific non-communicable disease mortality between April 1, 1996 and March 31, 2020, distinguishing mortality from (1) CVD and NADC, and from (2) liver, renal, and chronic respiratory disease (defined using ICD 9 and 10 codes). Using competing risk Cox regression, we modelled the association between female sex and mortality rates from each of these categories. We adjusted for baseline age and socio-structural factors: history of injection drug use, residence in Vancouver’s inner city, living in a rural area, and area-level income. We also adjusted for CD4 count at antiretroviral therapy (ART) initiation.
Results
A total of 11,738 males (baseline age 38 [IQR 32-46]) and 2,534 females (baseline age 34 [IQR 28,42]) with HIV were included; 92% and 88%, respectively, ever initiated ART. Over the study period, 587 males (5.0%) and 99 females (3.9%) died of CVD and NADC; 117 males (1.0%) and 53 females (2.1%) died from renal, liver, and respiratory disease. After age-adjustment, female sex was associated with a higher hazard ratio for mortality from CVD and NADC (1.18, 95% CI 0.95-1.47), but not significant, and significantly from renal, liver, and respiratory disease (2.84, 95% CI 2.05-3.97). After adjusting for socio-structural factors and CD4 count at ART initiation, female sex remained significantly associated with mortality from renal, liver, and chronic respiratory disease (Table 1).
Conclusions
The higher hazard for mortality from liver, renal, and chronic respiratory disease among females with HIV in BC could not be explained by socio-structural disparities and immune status at ART initiation. Our findings highlight the need for directed public health efforts, including preventive strategies and screening, for these diseases among females with HIV. These results should be explored in other settings.