Sex-based epidemiological and immunovirological characteristics of people living with HIV in current follow-up at a tertiary hospital: a comparative retrospective study, Catalonia, Spain, 1982 to 2020

Background: Epidemiological and immunovirological features of people living with HIV (PLWH) can vary by sex. Aim: To investigate, particularly according to sex, characteristics of PLWH who consulted a tertiary hospi-tal in Barcelona, Spain, in 1982-2020.Methods: PLWH, still in active follow-up in 2020 were retrospectively analysed by sex, age at diagnosis, age at data extrac-tion (December 2020), birth place, CD4+cell counts, and virological failure.Results: In total, 5,377 PLWH (comprising 828 women; 15%) were included. HIV diagnoses in women appeared to decrease from the 1990s, representing 7.4% (61/828) of new diagnoses in 2015-2020. From 1997, proportions of new HIV diag-noses from patients born in Latin America seemed to increase; moreover, for women born outside of Spain, the median age at diagnosis appeared to become younger than for those born in Spain, with signifi-cant differences observed in 2005-2009 and 2010- 2014 (31 vs 39 years (p = 0.001), and 32 vs 42 years (p < 0.001) respectively), but not in 2015-2020 (35 vs 42 years; p = 0.254). Among women, proportions of late diagnoses (CD4+cells/mm3 < 350) were higher than men (significantly in 2015-2020: 62% (32/52) vs 46% (300/656); p = 0.030). Initially, virological failure rates were higher in women than men, but they were similar in 2015-2020 (12% (6/52) vs 8% (55/659); p = 0.431). Women >= 50 years old represented 68% (564/828) of women actively followed up in 2020.Conclusions: Women still have higher rates of late HIV diagnoses than men. Among currently-followed -up women, >= 50 year-olds, who need age-adapted care represent a high percentage. Stratifying PLWH by sex matters for HIV prevention and control interventions.