Better outcomes of HIV-1 infection in women compared to men in an Ethiopian cohort.

Introduction: Sex influences the presentation and progression of various diseases. Studies regarding the impact of sex on the course and outcome of HIV may be biased due to differences in socioeconomic status between women and men and uneven sex representation, among other factors, resulting in conflicting data. Thus, this study compared men and women of similar ethnicity and social class who were diagnosed with HIV in two Israeli HIV care centers to minimize the effect of non-biological elements in this study cohort.

Methods: A retrospective HIV cohort of 334 women and 223 men diagnosed from 2000 to 2015. All patients were immigrants from Ethiopia who acquired HIV heterosexually and were of a similar socioeconomic status. Data regarding demographics, clinical status, virological (viral load [VL]) and immunological (CD4) status, and treatment modalities were collected for each patient.

Results: At HIV diagnosis, male were older than female (43.2 ± 13.2 vs. 35.4 ± 11.95 years; p < 0.0001) with a higher VL (372,086 ± 757,366 vs. 237,442 ± 756,371 copies/mL; p = 0.0443) and lower CD4 cell counts (240.74 ± 178 vs. 302.54 ± 218.89 cells/µL; p = 0.0006). Mean follow-up (9.94 ± 4.11 years) was similar between sexes. Women demonstrated significantly higher CD4 cell counts (492.6 ± 267.2 vs. 382.4 ± 214.7 cells/µL; p = 0.0001), lower AIDS rates (13.47% vs. 21.97%; p = 0.0147), and reduced mortality (6.29% vs. 16.59%; p = 0.0002) then men. These differences persisted in subgroup analyses stratified by age and immunological status at diagnosis (measured by CD4 cell counts and VL). In a multivariate analysis male sex emerged as an independent risk factor for death, AIDS, and low CD4 cell counts.

Conclusions: The clinical course and outcome of HIV infected women compared to men were more favorable, with lower rates of immunological impairment, AIDS, and mortality.