Life expectancy among women and men with HIV after achieving sustained virologic suppression in the Bronx, New York: a clinical cohort study

Background Whether female lifespan advantage is maintained among people with virologically suppressed HIV is unclear. Localized cohorts with demographically similar women and men may reveal associations obscured nationally. We estimated sex differences in life expectancy among people with HIV (PWH) in the Bronx, NY, after first achieving sustained virologic suppression. Methods Among PWH receiving care in Montefiore Health System in the Bronx, NY who achieved sustained virologic suppression for ≥1 year (1997–2021), follow-up began at the end of the earliest qualifying window (index date) and ended at death or 2023. A Poisson model estimated mortality rate ratios by age, sex, race/ethnicity, HIV acquisition category, CD4+ T-cell count, and health insurance at the index date; age-specific mortality rates estimated remaining life-years for a 30-year-old using Chiang's life table method. Findings PWH (n = 9999; 4075 [41%] women, 8392 [84%] Black or Hispanic) were followed for a median of 10.7 years; 2675 (27%) died. Men had 32% higher mortality risk than women (rate ratio: 1.32; 95% CI: 1.21–1.43). Compared to Black (non-Hispanic) PWH, Hispanic PWH had 19% lower mortality risk (RR: 0.81; 95% CI: 0.74–0.88), while those with White or other/unknown race/ethnicity had higher mortality risk. Among PWH with public insurance and CD4+ T-cell count ≥500 cells/μL, remaining life-years at age 30 were 45 and 41 for Hispanic women and men with heterosexual acquisition, 42 and 38 for Black women and men with heterosexual acquisition, and 44 and 41 for Hispanic and Black men with MSM acquisition. Interpretation Women with HIV in the Bronx after sustained virologic suppression lived approximately 4 years longer than comparable men, approaching sex differences in the general population. Local, disaggregated population analyses may help clarify sex differences in longevity among PWH, thereby informing clinical and public health priorities. Funding NIH.