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Factors mediating and associated with immunological response in women living with HIV in Sweden : A nationwide register-based study

Nilsson, Josefin ; Elvstam, Olof LU orcid ; Sörstedt, Erik ; Wagner, Philippe LU ; Nowak, Piotr ; Brännström, Johanna and Carlander, Christina (2025) In HIV Medicine 26(8). p.1311-1316
Abstract

INTRODUCTION: Women remain underrepresented in studies on immunological response (IR) among virally suppressed people living with HIV. Despite receiving antiretroviral therapy (ART) some individuals do not attain an IR, increasing their risk of non-AIDS morbidity and mortality. This nationwide study investigated biomedical and social factors associated with IR among women with HIV in Sweden.

METHODS: We conducted a register-based cohort study using the Swedish National HIV Registry (InfCareHIV). Virally suppressed women diagnosed with HIV between 2000 and 2020, ≥18 years old were included. Included women were observed for 2 years after ART initiation. The associations between IR and clinical and social determinants were... (More)

INTRODUCTION: Women remain underrepresented in studies on immunological response (IR) among virally suppressed people living with HIV. Despite receiving antiretroviral therapy (ART) some individuals do not attain an IR, increasing their risk of non-AIDS morbidity and mortality. This nationwide study investigated biomedical and social factors associated with IR among women with HIV in Sweden.

METHODS: We conducted a register-based cohort study using the Swedish National HIV Registry (InfCareHIV). Virally suppressed women diagnosed with HIV between 2000 and 2020, ≥18 years old were included. Included women were observed for 2 years after ART initiation. The associations between IR and clinical and social determinants were investigated using logistic regression.

RESULTS: There were 841 women included in the final model, of whom 90% (n = 739, 95% CI: 0.88-0.92) had an IR after a 2-year follow-up. Mean age was 37 years at inclusion, and 52% (n = 439) were born in a sub-Saharan African country. A significant interaction between baseline HIV viral load and HIV acquisition mode was observed. Higher baseline HIV viral load (≥100 000 copies/mL) increased the odds of IR (adjOR 1.81, 95% CI: 0.96-3.41), except among women acquiring HIV via intravenous drug use (IDU), where this association was strongly attenuated (adjOR: 0.03; 95% CI: 0.01-0.35). Baseline CD4, ART experience and age showed no significant associations.

CONCLUSIONS: The relationship between higher baseline HIV viral load and improved IR differed by HIV acquisition mode, suggesting the importance of tailored interventions addressing social determinants and immune activation. This potential interaction needs to be validated in future studies, also including sex-specific variables.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
HIV Medicine
volume
26
issue
8
pages
1311 - 1316
publisher
Wiley-Blackwell
external identifiers
  • scopus:105008075805
  • pmid:40501210
ISSN
1468-1293
DOI
10.1111/hiv.70059
language
English
LU publication?
yes
additional info
© 2025 The Author(s). HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
id
4fb877d4-d4e6-47e1-a46c-86506b98fbe7
date added to LUP
2025-06-14 08:58:02
date last changed
2025-12-08 12:31:49
@article{4fb877d4-d4e6-47e1-a46c-86506b98fbe7,
  abstract     = {{<p>INTRODUCTION: Women remain underrepresented in studies on immunological response (IR) among virally suppressed people living with HIV. Despite receiving antiretroviral therapy (ART) some individuals do not attain an IR, increasing their risk of non-AIDS morbidity and mortality. This nationwide study investigated biomedical and social factors associated with IR among women with HIV in Sweden.</p><p>METHODS: We conducted a register-based cohort study using the Swedish National HIV Registry (InfCareHIV). Virally suppressed women diagnosed with HIV between 2000 and 2020, ≥18 years old were included. Included women were observed for 2 years after ART initiation. The associations between IR and clinical and social determinants were investigated using logistic regression.</p><p>RESULTS: There were 841 women included in the final model, of whom 90% (n = 739, 95% CI: 0.88-0.92) had an IR after a 2-year follow-up. Mean age was 37 years at inclusion, and 52% (n = 439) were born in a sub-Saharan African country. A significant interaction between baseline HIV viral load and HIV acquisition mode was observed. Higher baseline HIV viral load (≥100 000 copies/mL) increased the odds of IR (adjOR 1.81, 95% CI: 0.96-3.41), except among women acquiring HIV via intravenous drug use (IDU), where this association was strongly attenuated (adjOR: 0.03; 95% CI: 0.01-0.35). Baseline CD4, ART experience and age showed no significant associations.</p><p>CONCLUSIONS: The relationship between higher baseline HIV viral load and improved IR differed by HIV acquisition mode, suggesting the importance of tailored interventions addressing social determinants and immune activation. This potential interaction needs to be validated in future studies, also including sex-specific variables.</p>}},
  author       = {{Nilsson, Josefin and Elvstam, Olof and Sörstedt, Erik and Wagner, Philippe and Nowak, Piotr and Brännström, Johanna and Carlander, Christina}},
  issn         = {{1468-1293}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{8}},
  pages        = {{1311--1316}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{HIV Medicine}},
  title        = {{Factors mediating and associated with immunological response in women living with HIV in Sweden : A nationwide register-based study}},
  url          = {{http://dx.doi.org/10.1111/hiv.70059}},
  doi          = {{10.1111/hiv.70059}},
  volume       = {{26}},
  year         = {{2025}},
}