1. AIDS 2018 | Abstract No. TUPDC0102 | Tuesday July 24, 2018
High mortality among women living with HIV enrolled in Canada's largest community-based cohort study
Angela Kaida1, Rebecca Gormley1,2, Kath Webster1, Allison Carter1,2, Valerie Nicholson1,3, Lu Wang2, Paul Sereda2, Robert S. Hogg1,2, Alexandra de Pokomandy4,5, Mona Loutfy6,7, CHIWOS Research Team
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada;
Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver Canada;
Canadian Aboriginal AIDS Network
Chronic Viral Illness Service, McGill University Health Centre, Montréal, Canada;
Department of Family Medicine, McGill University, Montréal, Canada;
Women's College Research Institute, Women's College Hospital, Toronto, Canada;
Department of Medicine, University of Toronto, Toronto, Canada;
We honour and remember the 65 women living with HIV who participated in CHIWOS from across Canada who have passed away.
@akaida
@DrAllieCarter
@CHIWOSresearch | 1

2. Background & Methods Inequities in life expectancy
Study & Analysis: CHIWOS
Wave 1: Baseline ( )
1,422 women
Wave 2: 18-months ( )
1,252 women (88% retention)
Wave 3: 36-months
(2017-present)
Death and cause of death: study notification and follow-up procedures, and confirmation via vital stats (in BC).
Time at risk of death: months between study start date (baseline) and end date (death, withdrawal, completed wave 3, LTFU/Declined wave 3, or Dec 1st, 2017).
Analyses:
Age-standardized mortality ratios
Proportional sub-distribution
hazards model
Patterson et al, BMC Infectious Dis. 2015
Objectives
Among women with HIV ≥16 years in Canada:
Measure crude all-cause mortality rate
Compare age-standardized mortality rate to the Canadian female population
Assess cause of death
Identify predictors of mortality
@akaida
@DrAllieCarter
@CHIWOSresearch | 2

3. Results
At baseline: median age was 42.5 years (IQR:35-50); 45% of women currently or previously used drugs; and most women were engaged in HIV medical care (93.5%), on ART (82.6%), and reported an undetectable viral load (77.1%).
54 women died of 1,422 enrolled (3.8%), as of Dec 1, 2017 (time of analysis)
Crude mortality rate = 11.8 per 1,000 woman-years (95% CI: )
Age-standardized mortality ratio = 4.54 times higher (95% CI: ) than female Cdn pop.
Cause of death = unknown (67%), co-morbidities including cancer and cardiovascular disease (15%), drug or alcohol use (11%), HIV-related opportunistic infections (6%), other causes (1.9%).
Baseline Factors
Unadjusted HR (95% CI)
Adjusted HR (95% CI)
Age at interview (per year increase)
1.05 (1.02, 1.07)
1.06 (1.03, 1.09)
Ethnicity: White
Indigenous
African/Caribbean/Black
Other ethnicity
1.00
1.35 ( )
0.20 (0.07, 0.57)
0.82 ( )
Not selected
Personal annual income < $20,000
3.08 (1.32, 7.21)
2.11 (0.81, 5.54)
Current sex work
2.35 ( )
Illicit drug use (past 3 months)
4.54 (2.27, 9.06)
Alcohol use: Non-binge drinkers
Binge drinkers
Heavy drinkers
1.25 (0.60, 2.62)
4.19 (1.50, 11.7)
0.95 (0.40, 2.28)
4.62 (1.66, 12.82)
Tobacco use: Never
Former
Current
5.71 (1.86, 17.5)
8.20 (3.22, 20.9)
3.26 (0.97, 10.94)
3.93 (1.45, 10.65)
Incarceration: Never
Ever
Last year
4.07 (2.22, 7.44)
3.32 (1.27, 8.65)
Depressive symptoms (CESD score ≥10)
2.08 (1.16, 3.73)
1.95 (0.97, 3.92)
Violence as adult (ever)
5.60 (1.36, 23.07)
Physical Health Summary Score (SF-12;/unit increase)
0.97 (0.95, 0.99)
@akaida
@DrAllieCarter
@CHIWOSresearch | 3

4. Discussion & Implications
We found an alarmingly high mortality rate.
No HIV-related clinical factors predicted mortality.
Co-morbidities, substance use (hazardous alcohol use, tobacco), and mental health present greater risks to survival.
Good HIV clinical care is necessary but not sufficient.
Women-centred HIV community outreach, social care services, and policies are urgently needed.
Prioritize peer support and leadership in these services.
@akaida
@DrAllieCarter
For more information: or
@CHIWOSresearch | 4