INSERM, U897, Bordeaux, France.
Int J Epidemiol. 2010 Feb;39(1):135-46. doi: 10.1093/ije/dyp300. Epub 2009 Oct 5.
Little is known about the causes of death in human immunodeficiency virus (HIV)-infected women in the era of combination antiretroviral therapy (ART).
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.
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.
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.
在联合抗逆转录病毒疗法（ART）时代，人们对感染人类免疫缺陷病毒（HIV）的女性的死亡原因知之甚少。
在法国全国 2000 年和 2005 年死亡率调查中，医生使用标准化问卷报告了 2000 年和 2005 年感染 HIV 的成年人的死亡原因。我们使用多变量逻辑回归模型研究了性别与艾滋病定义的死亡原因之间的关联，同时调整了其他特征。
在 2005 年死亡的 1013 名感染 HIV 的成年人中，有 247 名（24%）为女性。一半的女性是通过异性接触感染的，而男性则为 25%。2005 年，女性艾滋病定义的死亡原因比例高于男性（43%比 34%；P=0.01），而 2000 年则相同（女性和男性均为 47%）。2005 年，女性死于呼吸道恶性肿瘤（肺部、耳/鼻/喉）和心血管疾病的频率低于男性（女性占所有死因的 9%，而男性为 16%；P=0.004），自杀或意外的比例也较低（4 比 9%；P=0.02）。社会经济不稳定、年龄较小、较少饮酒和吸烟以及缺乏前期 ART 解释了女性与男性相比艾滋病死亡比例较高的原因。
女性中与艾滋病相关的死亡比例较高可能有两个原因：（i）一些感染 HIV 的女性，尤其是社会经济条件较差的移民，可能无法获得最佳治疗；（ii）与呼吸道、心血管和暴力死亡相关的风险因素的流行率较低，这意味着女性死于非艾滋病原因的风险可能较低。
