Gender differences in HIV disease progression and treatment outcomes among HIV patients one year after starting antiretroviral treatment (ART) in Dar es Salaam, Tanzania (original) (raw)
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2008
• By 2005, an estimated 500 000 people with HIV had initiated highly active antiretroviral therapy (HAART) in sub-Saharan Africa. However, disproportionately more women than men have accessed HAART in most developing countries including South Africa. While there has been considerable recent interest in the determinants of mortality among patients receiving HAART in developing countries, there is conflicting evidence about gender differences and survival in HAAR T programmes. This study explored whether there were gender differences in early mortality among 2 843 treatment-naive men and women entering care in a large South African HAART programme. The study was a secondary analysis of patient records covering three time periods: person-time from programme entry to the initiation ofHAART; person-time from HAART initiation to one year on treatment; and the total person-time from programme entry to one year on HAART. Cox' s proportional hazards regression •was used to investigate crude and adjusted associations between basehne characteristics and mortality as we11 as loss-to-follow-up (LTFU). Using the Sobel test, the study explored whether the degree of disease (according to CD4 count and WHO stage) played a mediating role in any association between gender and mortality. In all three time periods, the analysis found a strong crude associ~tiol). between male gender and mortality. Prior to HAART-initiation, there was a 31 % increase in the risk of mortality (crude Hazard Ratio (HR) 1.31, 95% CI, 0.93-1.86; p=0.131). In the period on HAART, this association strengthened (crude HR 1.57, 95% CI, 1.14-2.16; p=0.005). Overall, male gender increased the risk of mortality in the total cohort by 49% (crude HR, 1.49, 95% CI, 1.17-1.88; p=OOl). Adjustment for baseline characteristics, including CD4 count and WHO stage, attenuated these crude associations. After adjustment, there was no increase in risk associated with male gender in the period pre-HAART (HR 1.01, 95% CI, 0.67-1.51). On HAART, there was a 19% increase in risk (HR 1.19, 95% CI, 0.88-1.67). In the total cohort, this was slightly attenuated (HR 1.15, 95% CI, TABLE OF CONTENTS 1
Journal of the International AIDS Society, 2011
Background: Because men in Africa are less likely to access HIV/AIDS care than women, we aimed to determine if men have differing outcomes from women across a nationally representative sample of adult patients receiving combination antiretroviral therapy in Uganda. Methods: We estimated survival distributions for adult male and female patients using Kaplan-Meier, and constructed multivariable regressions to model associations of baseline variables with mortality. We assessed person-years of life lost up to age 55 by sex. To minimize the impact of patient attrition, we assumed a weighted 30% mortality rate among those lost to follow up. Results: We included data from 22,315 adults receiving antiretroviral therapy. At baseline, men tended to be older, had lower CD4 baseline values, more advanced disease, had pulmonary tuberculosis and had received less treatment follow up (all at p < 0.001). Loss to follow up differed between men and women (7.5 versus 5.9%, p < 0.001). Over the period of study, men had a significantly increased risk of death compared with female patients (adjusted hazard ratio 1.43, 95% CI 1.31-1.57, p < 0.001). The crude mortality rate for males differed importantly from females (43.9, 95% CI 40.7-47.0/1000 person-years versus 26.9, 95% CI 25.4-28.5/1000 person years, p < 0.001). The probability of survival was 91.2% among males and 94.1% among females at 12 months. Person-years of life lost was lower for females than males (689.7 versus 995.9 per 1000 person-years, respectively). Conclusions: In order to maximize the benefits of antiretroviral therapy, treatment programmes need to be gender sensitive to the specific needs of both women and men. Particular efforts are needed to enroll men earlier into care.
BMC Infectious Diseases, 2012
Background: Impact of gender on time to initiation, response to and risk of modification of highly active antiretroviral therapy (HAART) in HIV-1 infected individuals is still controversial. Methods: From a nationwide cohort of Danish HIV infected individuals we identified all heterosexually infected women (N=587) and heterosexually infected men (N=583) with no record of Hepatitis C infection diagnosed with HIV after 1 January 1997. Among these subjects, 473 women (81%) and 435 men (75%) initiated HAART from 1 January 1997 to 31 December 2009. We used Cox regression to calculate hazard ratio (HR) for time to initiation of HAART, Poisson regression to assess incidence rate ratios (IRR) of risk of treatment modification the first year, logistic regression to estimate differences in the proportion with an undetectable viral load, and linear regression to detect differences in CD4 count at year 1, 3 and 6 after start of HAART.
A Second Look at the Association between Gender and Mortality on Antiretroviral Therapy
PloS one, 2015
We assessed the association between gender and mortality on antiretroviral therapy (ART) using identical models with and without sex-specific categories for weight and hemoglobin. Cohort study of adult patients on ART. GHESKIO Clinic in Port-au-Prince, Haiti. 4,717 ART-naïve adult patients consecutively enrolled on ART at GHESKIO from 2003 to 2008. Mortality on ART; multivariable analyses were conducted with and without sex-specific categories for weight and hemoglobin. In Haiti, male gender was associated with mortality (OR 1.61; 95% CI: 1.30-2.00) in multivariable analyses with hemoglobin and weight included as control variables, but not when sex-specific interactions with hemoglobin and weight were used. If sex-specific categories are omitted, multivariable analyses indicate a higher risk of mortality for males vs. females of the same weight and hemoglobin. However, because males have higher normal values for weight and hemoglobin, the males in this comparison would generally hav...
International Journal of Women's Health, 2010
The purpose of this study was to examine gender differences in mortality for human immunodeficiency virus (HIV) patients in rural Western Uganda after six months of highly active antiretroviral therapy (HAART). Three hundred eighty five patients were followed up for six months after initiating HAART. Statistical analysis included descriptive, univariate and multivariate methods, using Kaplan-Meier estimates of survival distribution and Cox proportional hazards regression. Mortality in female patients (9.0%) was lower than mortality in males (13.5%), with the difference being almost statistically significant (adjusted hazard ratio for females 0.55; 95% confidence interval [CI]: 0.28-1.07; P = 0.08). At baseline, female patients had a significantly higher CD4+ cell count than male patients (median 147 cells/µL vs 120 cells/µL; P 0.01). A higher CD4+ cell count and primary level education were strongly associated with better survival. The higher CD4+ cell count in females may indicate that they accessed HAART services at an earlier stage of their disease progression than males. A borderline statistically significant lower mortality rate in females shows that females fare better on treatment in this context than males. The association between lower mortality and higher CD4+ levels suggest that males are not accessing treatment early enough and that more concerted efforts need to be made by HAART programs to reach male HIV patients.
2016
Objectives: To describe CD4 immunological failure in male and female HIV treatment naïve patients on HAART at Itezh-itezhi District Hospital. To achieve this objective the study was aimed at identifying and comparing CD4 immunological failure between male and female HIV treatment naïve patients on antiretroviral therapy. Study Method: A descriptive cross-section study was employed to collect secondary data from patient files. Data collected was serum CD4 cell count at baseline of ART enrolment and Six (6) months of treatment. The unit analysis was adult treatment naïve patients at least six months on antiretroviral therapy at Itezhi-tezhi District Hospital in Central Province of Zambia. A probability Simple random method of sampling was used to pick files of participants. The files were first entered on excel spreadsheet, allocated a random number and randomized. Thereafter,thefirst246files will be selected and used in this study. Results: As of June 2015, the cumulative ever on ART at Itezhi-tezhi district was 4073 and out of this figure 1465 (36%) had died, migrated or lost to follow. Currently, there were only 2508 on ART and out of this figure a higher population was that of the adult female. Using the Pearson Chi-square test, it was found that those gender differences were significantly associated with CD4 immunological failure and men were more vulnerable. Conclusion; Men on ART were found to have a higher prevalence of CD4 immunological failure compared to women, regardless of their baseline, Age, weight and CD4 count. However, additional studies are needed to confirm men`s susceptibility to treatment failure by incorporating virological and clinical monitoring in these studies.