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British Columbia study finds sex differences in the health of people living with HIV
CATIE News
September 24, 2026
- A B.C. study compared health indicators among people with HIV based on sex assigned at birth
- At ages 20 and 40, those assigned male at birth had more years free from comorbidities
- Researchers noted higher substance use among study participants assigned female at birth
HIV treatment (antiretroviral therapy, ART) has had a tremendous impact on the survival of people with HIV. Researchers increasingly expect that many people taking ART can have a life expectancy approaching that of their peers without HIV. However, this rosy forecast may not apply to all populations. For instance, a study in British Columbia of people with HIV found that between 2012 and 2020, those assigned male at birth had eight more years of life expectancy than those assigned female at birth. This difference occurred despite the availability of universal healthcare and subsidized access to ART.
An important issue is whether gains in life expectancy are also linked to substantial gains in years of good health (healthy life expectancy). To explore this, a team of researchers at the BC Centre for Excellence in HIV/AIDS, the University of British Columbia and Simon Fraser University analyzed several databases. They focused on 14,135 people with HIV—11,624 were assigned male at birth and 2,511 were assigned female at birth. Data were collected over a period of 24 years (between 1996 and 2020) and all participants were adults at the time they entered the study.
Results
Age-related comorbidities
Researchers found that, at ages 20 and 40, those assigned male at birth could expect to live more years without age-related comorbidities than those assigned female at birth. However, by the time participants were 55 years old, the differences were not significant.
Multiple comorbidities
At ages 20 and 40, those assigned male at birth had more years free from multiple comorbidities than those assigned female at birth, but not at age 55.
Mental health conditions
At ages 20 and 40, those assigned male at birth had more years free from mental health conditions compared to those assigned female at birth. However, by age 55, there were no significant differences.
What are the factors driving the differences based on sex assigned at birth?
The researchers noted that in study participants “a history of [injecting drugs] was more common among those assigned female at birth (44%) than those assigned male at birth (26%).”
The researchers elaborated: “Substance use, which in Canada is generally higher among females than males with HIV, and biological factors such as ongoing inflammation and immune dysregulation may contribute to this sex difference among [people with HIV]. Research shows that females persistently have higher levels of immune activation and inflammation than males with suppressed HIV viremia. In addition, females living with HIV may face unique intersecting socio-structural challenges, including poverty, unstable housing, stigma and other barriers to care, which can exacerbate the development and management of comorbidities, contributing to greater multimorbidity in this population.”
What to do?
The B.C. scientists stated: “Our research underscores the need for targeted interventions to address age-related and mental health conditions among [people with HIV], especially females, who are disproportionately impacted. This should include scaling up integrated models of care that combine HIV treatment, chronic disease management, mental healthcare and harm reduction, with particular attention to the needs of women and individuals with histories of substance use.”
—Sean R. Hosein
Resources
BC Centre for Excellence in HIV/AIDS
A Pocketbook for Women-Centred Care —Women’s College Hospital
A gender-specific supervised consumption service — Programming Connection
Exploring gender in harm reduction: Toward more inclusive and responsive services — Prevention in focus
REFERENCES:
- Kooij KW, Naidu N, Zhang W, et al. Years gained, health lost? A population-based cohort study of sex differences in healthy life expectancy among people living with HIV. BMJ Open. 2026 Jul 22;16(7):e120182.
- Trickey A, Sabin CA, Burkholder G, et al. Life expectancy after 2015 of adults with HIV on long-term antiretroviral therapy in Europe and North America: a collaborative analysis of cohort studies. Lancet HIV. 2023 May;10(5): e295-e307.
- Trickey A, McGinnis K, Gill MJ, et al. Longitudinal trends in causes of death among adults with HIV on antiretroviral therapy in Europe and North America from 1996 to 2020: a collaboration of cohort studies. Lancet HIV. 2024 Mar;11(3): e176-e185.
- Kooij KW, Marziali M, Budu M, et al. Incidence and trends of non-fatal overdoses among people with and without HIV: a population-based cohort study in British Columbia, Canada (2012-2020). BMJ Open. 2025 Nov 24;15(11):e103778.
- Kooij KW, Zhang W, Trigg J, et al. Life expectancy and mortality among males and females with HIV in British Columbia in 1996-2020: a population-based cohort study. Lancet Public Health. 2025 Mar;10(3):e228-e236.
- Patterson S, Cescon A, Samji H, et al. Life expectancy of HIV-positive individuals on combination antiretroviral therapy in Canada. BMC Infectious Diseases. 2015 Jul 17; 15:274.
- Angel JB, Freilich J, Arthurs E, et al. Adherence to oral antiretroviral therapy in Canada, 2010-2020. AIDS. 2023 Nov 1;37(13):2031-2040.
- Althoff KN, Chandran A, Zhang J, et al. Life-Expectancy Disparities Among Adults With HIV in the United States and Canada: The Impact of a Reduction in Drug- and Alcohol-Related Deaths Using the Lives Saved Simulation Model. American Journal of Epidemiology. 2019 Dec 31;188(12):2097-2109.
- Gueler A, Moser A, Calmy A, et al. Life expectancy in HIV-positive persons in Switzerland: matched comparison with general population. AIDS. 2017 Jan 28;31(3):427-436.
From Canadian AIDS Treatment Information Exchange (CATIE).
This content was originally published by CATIE, Canada’s source for HIV and hepatitis C information.
Source: CATIE:
https://www.catie.ca/catie-news/british-columbia-study-finds-sex-differences-in-the-health-of-people-living-with-hiv
For more information visit CATIE's Information Network at www.catie.ca
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