Sex differences in incident atherosclerotic cardiovascular disease events among women and men with HIV

Abstract

Background: The protective advantage against atherosclerotic cardiovascular disease (ASCVD) experienced by women compared to men in the general population is diminished in some high- risk populations. People with HIV have a higher risk for ASCVD compared to the general population. Objective: Compare the incidence of ASCVD among women versus men with HIV. Methods: We analyzed data from women (n = 17 118) versus men (n = 88 840) with HIV, and women (n = 68 472) and men (n = 355 360) matched on age, sex, and calendar year of enrollment without HIV who had commercial health insurance in the MarketScan database between 2011 and 2019. ASCVD events during follow-up, including myocardial infarction, stroke, and lower-extremity artery disease, were identified using validated claims-based algorithms. Results: Among those with and without HIV, the majority of women (81.7%) and men (83.6%) were <55 years old. Over a mean follow-up of 2.25–2.36 years depending on sex-HIV sub-group, the ASCVD incidence rate per 1000 person-years was 2.87 [95% confidence interval (CI) 2.35, 3.40] and 3.61 (3.35, 3.88) among women and men with HIV, respectively, and 1.24 (1.07, 1.42) and 2.57 (2.46, 2.67) among women and men without HIV, respectively. After multivariable adjustment, the hazard ratio for ASCVD comparing women to men was 0.70 (95% CI 0.58, 0.86) among those with HIV and 0.47 (0.40, 0.54) among those without HIV (P-interaction = 0.001). Conclusion: The protective advantage of female sex against ASCVD observed in the general population is diminished among women with HIV. Earlier and more intensive treatment strategies are needed to reduce sex-based disparities.