Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
Braz J Infect Dis. 2023 Mar-Apr;27(2):102740. doi: 10.1016/j.bjid.2023.102740. Epub 2023 Jan 31.
Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation.
We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models.
Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35-3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different.
We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.
抗逆转录病毒疗法的使用导致与艾滋病毒相关的死亡率下降，但性别和/或性取向方面可能存在差异。在这项研究中，我们根据性别和性取向估计了艾滋病毒感染者（PLWH）的死亡风险。
我们纳入了 2000 年至 2018 年期间在巴西里约热内卢 INI/Fiocruz 登记的年龄≥18 岁的 PLWH。参与者分为顺性别或跨性别女性、与男性发生性关系的顺性别男性（MSM）或与女性发生性关系的男性，或顺性别男性，性取向未知。我们使用 Cox 比例风险模型评估死亡风险的差异。
在 5576 名 PLWH 中，中位入组年龄为 35 岁，39%为 MSM，28%为顺性别女性，23%为与女性发生性关系的男性，5%为跨性别女性，5%为性取向未知的男性。在 39141 人年的随访中，共有 795 人死亡。每 1000 人年的死亡率为：性取向未知的男性为 82.4，与女性发生性关系的男性为 24.5，顺性别男性为 18.3，跨性别女性为 16.6，MSM 为 15.1。与 MSM 相比，性取向未知的男性死亡风险比最高（调整后的风险比 [aHR] 2.93，95%置信区间 [CI] 2.35-3.81），其次是与女性发生性关系的男性（aHR 1.17，95%CI 0.96，1.43）；顺性别和跨性别女性的死亡风险比没有统计学差异。
尽管巴西普遍获得了抗逆转录病毒治疗，但我们观察到性取向未知的男性和与女性发生性关系的男性的死亡风险存在差异。未来的工作应该针对性取向未知的男性，并制定有针对性的政策和干预措施来帮助他们。没有观察到跨性别女性的死亡风险增加，这可能是因为我们的服务中实施了干预措施，以接触、参与、留住和支持这一人群。
