Background

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.

Methods

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.

Results

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.

Conclusion

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.

中文翻译：

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按性别和性取向划分的死亡率显示，在巴西里约热内卢的艾滋病毒感染者群体中，性取向不明的顺性别男性和与女性发生性行为的男性死亡率异常高

背景

抗逆转录病毒疗法的使用导致艾滋病毒相关死亡率下降，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算了艾滋病毒感染者 (PLWH) 的死亡风险。

方法

我们纳入了 2000 年至 2018 年间在巴西里约热内卢 INI/Fiocruz 登记的≥ 18 岁的 PLWH。参与者被分为顺性别或跨性别女性、男男性行为者 (MSM) 或与女性发生性行为的男性、或性取向未知的顺性别男性。我们使用 Cox 比例风险模型评估了死亡风险的差异。

结果

在 5,576 名 PLWH 中，入组时的中位年龄为 35 岁，其中 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% 为性取向不明的男性。在 39,141 人年的随访中，共有 795 人死亡。每千人年死亡率为：性取向不明的男性为 82.4，与女性发生性关系的男性为 24.5，顺性别为 18.3，跨性别女性为 16.6，MSM 为 15.1。与 MSM 相比，性取向不明的男性死亡风险比最高（调整后风险比 [aHR] 2.93，95% 置信区间 [CI] 2.35–3.81），其次是与女性发生性行为的男性（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。

结论

我们观察到，尽管巴西普遍接受抗逆转录病毒治疗，但性取向不明的男性和与女性发生性行为的男性的死亡风险存在差异。未来的工作应该通过量身定制的政策和干预措施来描述和帮助未知性取向的男性。跨性别女性的死亡风险并未增加，这可能是由于我们为接触、吸引、留住和支持这一人群而实施的干预措施所致。