Abstract:
Background: Women account for over half of persons living with HIV/AIDS globally.
We examined geographic variation in all-cause mortality after antiretroviral therapy
(ART) for women living with HIV (WLWH) worldwide.
Methods: We pooled data from WLWH at least 18 years initiating ART 2000–2014
within COHERE (Europe) and IeDEA regions (East Africa, West Africa, South Africa,
North America, Latin America/Caribbean). Mortality rates were calculated at 0–3, 3–6,
6–12, 12–24 and 24–48 months after ART, and mortality rate ratios were compared
with European rates with piecewise exponential parametric survival models based on
Poisson regression.
Findings: One hundred ninety thousand, one hundred and seventy-five WLWH (16%
Europe, 47% East Africa, 13% West Africa, 19% South Africa, 1% South America, 3%
North America and 2% Central America/Caribbean) were included. The highest death
rates occurred 0–3 months after ART [1.51 (95% CI 1.25–1.82) per 100 person-years in
Europe, 12.45 (11.30–13.73), 14.03 (13.12–15.02) and 9.44 (8.80–10.11) in East,
West and South Africa, and 1.53 (0.97–2.43), 7.83 (5.44–11.27) and 17.02 (14.62–
19.81) in North, South America and Central America/Caribbean, respectively] and
declined thereafter. Mortality in Europe was the lowest, with regional differences
greatest in the first 3 months and smaller at longer ART durations [adjusted rate ratios
24–48 months after ART: 3.63 (95% CI 3.04–4.33), 5.61 (4.84–6.51) and 3.47 (2.97–
4.06) for East, West and South Africa; 2.86 (2.26–3.62), 2.42 (1.65–3.55) and 2.50
(1.92–3.26) for North, South America and Central America/Caribbean, respectively].
Conclusion: Global variations in short-term and long-term mortality among WLWH
initiating ART may inform context-specific interventions.