Shiraz E-Med J. 2015 January; 15 (4): e24273. Published online 2014 November 23. Research Article Gender Differences in Progression to AIDS and Death After HIV Diagnosis Nasrin Motazedian 1 ; Mehrab Sayadi 2,* ; Parvin Afsar Kazerooni 1 ; Mojghan Sabet 2 1 Shiraz HIV/AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran 2 Vice Chancellor for Health Affairs, Shiraz University of Medical Sciences, Shiraz, Iran *Corresponding Author: Mehrab Sayadi, Vice Chancellor for Health Affairs, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel/Fax: +98-7112122495, E-mail: sayadi_me@yahoo. com Received: October 1, 2014; Accepted: October 4, 2014 Background: The underlying mechanisms of HIV infection and its social and economical consequences significantly differ between men and women. Objectives: The aim of this study was to examine gender differences in Human Immunodeficiency Virus (HIV) progression to acquired immune deficiency syndrome (AIDS) and death among people living with HIV in Shiraz. Patients and Methods: A historical cohort study (1996 to 2012) was conducted using data obtained from Shiraz voluntary counseling and testing center. Subjects infected by HIV, who were 17 years or older and antiretroviral therapy (ART) naive were included in this study. Basic demographic information, such as age at diagnosis, current age, gender, mode of HIV transmission, and education were extracted based on the dates of the reported positive Western-Blot (WB) tests. Results: Among the 1721 enrolled subjects who met the inclusion criteria, 1456 (84.6%) were male and 265 (15.4%) were female. Among all transmission routes, injecting drug use (IDU) was the most frequent for men (1262 = 86.7%) and sexual transmission was the most frequent for women (226 = 85.3%). The mean (SE) time of HIV to AIDS was 35.98 ± 0.95 months; 38.04 ± 1.09 for men and 27.85 ± 1.80 for women (P < 0.001, log rank test). Mean (SE) time of HIV to death was 31.74 ± 1.36 months; 31.83 ± 1.41 for men and 31.15 ± 4.47 for women (P = 0.773, log rank test). Conclusions: This study showed that HIV-infected women, as compared with men, had faster progression to AIDS. This result may indicate that women refer to health centers late, so they are diagnosed during the developed stages of the infection. Uninvited and multivariate tests were used and no difference was found between survival time of men and women. Keywords:AIDS; Survival; HIV; Diagnosis; Gender Copyright © 2014, Shiraz University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCom- mercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial us- ages, provided the original work is properly cited. 1. Background According to the United Nations Program on acquired immune deficiency syndrome (UNAIDS) reports, 62% of youth infected with Human Immunodeficiency Virus (HIV) are women and this difference is increasing (1). In Asia, approximately 50 million women are at risk of ac- quiring HIV from their sexual male partner with high risk behavior such as paid sex, injecting drug use, unsafe ho- mosexual intercourse. Limitations in accessing HIV pre- vention, treatment and care services, and economic con- straints are examples of gender inequality as a key driver of the HIV epidemic (2). The underlying mechanisms of HIV infection and the social and economic consequences of this infection sig- nificantly differ between men and women. The differ- ences come from biology, sexual behavior and gender differences between men and women in roles and re- sponsibilities and access to resources. The difference in HIV prevalence between men and women is narrowing. The differences in sexual transmission of HIV, pregnancy and childbearing are important issues in this field. Gen- der norms, violence, health-seeking behavior, health pro- grams and services are other related issues (3). A collaboration of 23 HIV seroconvert cohort studies from Europe, Australia and Canada reported no signifi- cant gender difference before 1997, but from 1997 on- wards, women had a lower risk of AIDS and death (4). A Swiss HIV cohort study has shown that mortality risk for men and women was the same. There are conflicting results regarding this issue (5). Results from the United States showed that among those not undergoing ther- apy, women had lower survival rate compared to men but gender did not affect the survival of individuals who were undergoing antiviral therapy (6). In comparison to men an equal duration of infection, women have higher CD4 and lower viral load. In general, these findings do not interpret progression rate or re- sponse to highly active antiretroviral therapy (HAART) (7). A cohort study on injecting drug users in Spain showed that HIV progression was different between participants, and women experienced lower HIV progression before and after 1997 and their compliance with medicine was higher than men. In most studies no difference has been shown in HIV progression to AIDS relative to gender. However, some have found a number of differences be-