Utilización de servicios sanitarios según el sexo en una cohorte de usuarios de drogas por vía parenteral infectados por el virus de la inmunodeficiencia humanaHealth services utilization according to gender in a cohort of intravenous drug users infected with HIV

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Fundamento Y Objetivo

Se han descrito diferencias por sexo tanto en el uso de los servicioscomo en el acceso a los tratamientos antirretroviral y profiláctico en personas infectadas por elvirus de la inmunodeficiencia humana (VIH). El objetivo de este estudio es determinar las característicasdel uso de los servicios de salud según el sexo en usuarios de drogas por vía parenteral(UDVP) con infección por el VIH.

Pacientes Y Método

Cohorte prospectiva de UDVP que incluyó a 926 sujetos infectados por elVIH en su primera visita, entre enero de 1987 y diciembre de 1996. Generaron 3.429 visitasen distintos servicios sanitarios. Se ajustaron modelos de regresión logística utilizando métodosrobustos para estimar las odds ratio (OR).

Resultados

De las 926 personas estudiadas, el 25,4% eran mujeres. Aunque no hubo diferenciasrelevantes por sexo en el uso de los distintos servicios sanitarios, desde la introducción delos tratamientos antirretrovirales de gran actividad, los varones han tenido menos ingresos hospitalariosque las mujeres (OR = 0,50; intervalo de confianza [IC] del 95%, 0,25–0,99). Desdela introducción de estos tratamientos se ha detectado una mayor prescripción a los varones detratamiento antirretroviral (OR = 1,30; IC del 95%, 0,97–1,24), profilaxis de tuberculosis (OR= 2,22; IC del 95%, 1,24–4,16) y de Pneumocystis carinii (OR = 1,50; IC del 95%, 1,17–1,91). Estas asociaciones se atenuaron al ajustar por variables sociodemográficas y de estadoclínico, excepto para la profilaxis de P. carinii

Conclusión

No hay diferencias relevantes por sexo en el cuidado de la enfermedad por el VIH.Los beneficios de los antirretrovirales de gran actividad pueden tener un impacto menor a cortoplazo en las mujeres, dependiendo de la prescripción y de otras variables que deben confirmarseen estudios de seguimiento a más largo plazo.

Background and objective

Gender differences among HIV infected persons have been described in the utilization of health-care services and in their access to anti-retroviral and prophylactic treatments. The aim of this study was to determine the characteristics of the health service utilization according to gender in a cohort of intravenous drug users (IVDU) with HIV infection.

Patients and method

Prospective cohort study of 926 IVDU who tested positive for HIV infection in their first visit between January 1987 and December 1996. These participants generated 3,429 visits in different health-care centers. Odds ratio (OR) and their 95% confidence intervals (95%CI) were estimated by multiple logistic regression analysis using robust methods.

Results

Out of 926 subjects, 25.4% were women. Although there were not clear differences by sex in the use of health-care centers, we observed that since the introduction of highly active antiretroviral treatments (HAART) men have had fewer hospital admission than women (OR = 0.50; 95%CI: 0.25–0.99). Moreover, once HAART was started, men received higher prescriptions of antiretroviral treatment than women (OR = 1.30; 95%CI: 0.97–1.24), as well as a higher number of prescriptions for prevention of tuberculosis (OR = 2.22; 95%CI: 1.24–4.16) and Pneumocystis carinii pneumonia (PCP) (OR = 1.50; 95 % CI: 1.17–1.91). These associations were attenuated when sociodemographic and clinical status variables were taken into account, except for PCP treatment.

Conclusion

No relevant differences according to gender were observed in the care of HIV disease. The benefits of HAART may have a minor impact among women in the short term, depending on prescriptions and the other variables considered. These findings must be confirmed by studies with longer follow-up periods.

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