Gender differences in clinical and immunological outcomes in South African HIV-infected patients on HAART
Date
2008-09-01T13:17:15Z
Authors
Maskew, Mhairi
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Abstract
ABSTRACT
Introduction
South Africa is estimated to have the largest number of HIV infected adults in Southern
Africa with a higher HIV prevalence in females compared to males. While significant
reductions in morbidity and mortality due to HIV and AIDS have been realized for over a
decade internationally, HIV treatment involving highly active antiretroviral therapy
(HAART) is still a relatively new phenomenon in this country and gender differences in
HIV outcomes between males and females in South Africa have not been previously well
described. This study aimed to determine and describe gender differences in clinical and
immunological outcomes in a population of HIV infected South African adults initiated
on HAART.
Materials and Methods
This retrospective data analysis reviewed 6,617 HIV-infected adultsABSTRACT
Introduction
South Africa is estimated to have the largest number of HIV infected adults in Southern
Africa with a higher HIV prevalence in females compared to males. While significant
reductions in morbidity and mortality due to HIV and AIDS have been realized for over a
decade internationally, HIV treatment involving highly active antiretroviral therapy
(HAART) is still a relatively new phenomenon in this country and gender differences in
HIV outcomes between males and females in South Africa have not been previously well
described. This study aimed to determine and describe gender differences in clinical and
immunological outcomes in a population of HIV infected South African adults initiated
on HAART.
Materials and Methods
This retrospective data analysis reviewed 6,617 HIV-infected adults initiated on HAART
at the Themba Lethu Clinic, an urban public-sector antiretroviral rollout facility in
Johannesburg, South Africa between 1st April 2004 and 31st March 2007. Clinical data
from these antiretroviral naïve patients was analysed for gender differences in mortality,
rates of loss to follow up, CD4 cell count response, virologic suppression and weight
gain. Cox regression models and logistic regression models were used to estimate hazard
ratios (HR) and odds ratios (OR), respectively, for associations between gender and
outcomes. Models were adjusted for age and baseline CD4 count.
Results
At baseline, 4,388 (66.3%) women were significantly younger (p<0.0001) and less likely to be employed than the 2,229 (33.7%) men (p<0.001). Furthermore, women
had significantly higher baseline CD4 counts (p<0.0001) and higher body mass index
(BMI) (p<0.0001). Males experienced significantly reduced survival compared to females
(p=0.0053) by Kaplan-Meier analysis. In adjusted multivariate analysis, men were 22%
more likely to die or become lost to follow up than women [HR = 1.22 (95% CI 1.06 -
1.39]. The period with the highest risk of mortality or loss to follow up was within six
months of starting HAART.
Female gender was associated with better CD4 count response. In multivariate analysis
adjusted for age and baseline CD4 count, women were 35% more likely to achieve a 100
cell increase in CD4 count at four months after initiation of HAART [OR =1.35 (95% CI
= 1.19 -1.54)] and 45% more likely to increase their CD4 counts by 100 cells/mm3 after
ten months on HAART [OR =1.42 (95% CI = 1.20 -1.68)] when compared to men.
Women were also more likely to achieve virologic suppression at ten months post
HAART initiation [OR =1.54 (95% CI =1.21-1.97)] and were more likely to have gained
weight after four months on treatment than males [OR = 1.26 (95% CI = 1.07–1.49)] after
adjusting for age, baseline CD4 count and baseline BMI.
Conclusions
Women had significant advantages over men in terms of short-term clinical and
immunological outcomes. Earlier access treatment for men should be facilitated and
adherence should be promoted once on treatment. Further research is required to
determine if these gender differences persist during long-term HAART.
Description
Keywords
gender differences, HAART, HIV infections