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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The vulnerability of men to virologic failure during antiretroviral therapy in a public routine clinic in Burkina Faso
Journal of the International AIDS Society, Volume 17, Article 18646, Year 2014
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Description
Introduction: Gender differences in antiretroviral therapy (ART) outcomes are critical in sub-Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso. Methods: We performed a case-control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV-1 or HIV-1+2, and on first-line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads <300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART. Results: Of 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viroimmunologic failure, and four (2.3%) had viro-clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p < 0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor-based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77-3.60; p < 0.001). Conclusions: Men on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting. © 2014 Penot P et al; licensee International AIDS Society.
Authors & Co-Authors
Penot, Pauline
Burkina Faso
Hôpital de Jour du Service de Médecine Interne du Chu Sanou Souro
France, Montpellier
Ird Centre de Montpellier
Héma, Arsène
Burkina Faso
Hôpital de Jour du Service de Médecine Interne du Chu Sanou Souro
Bado, Guillaume
Burkina Faso
Hôpital de Jour du Service de Médecine Interne du Chu Sanou Souro
Kabore, Nongodo Firmin
Burkina Faso
Hôpital de Jour du Service de Médecine Interne du Chu Sanou Souro
Soré, Ibrahim
Burkina Faso
Hôpital de Jour du Service de Médecine Interne du Chu Sanou Souro
Sombié, Diamasso
Burkina Faso
Hôpital de Jour du Service de Médecine Interne du Chu Sanou Souro
Traoré, Jean Richard
Burkina Faso
Hôpital de Jour du Service de Médecine Interne du Chu Sanou Souro
Guiard-Schmid, J. B.
Burkina Faso, Ouagadougou
Initiatives Conseil International - Santé
Fontanet, A. L.
France, Paris
Institut Pasteur, Paris
France, Paris
Conservatoire National Des Arts et Metiers
Slama, Laurence
France, Paris
Hôpital Tenon
Sawadogo, Adrien Bruno
Burkina Faso
Hôpital de Jour du Service de Médecine Interne du Chu Sanou Souro
Laurent, Christian
France, Montpellier
Ird Centre de Montpellier
Statistics
Citations: 45
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.7448/IAS.17.1.18646
e-ISSN:
17582652
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Case-Control Study
Study Locations
Multi-countries
Burkina Faso
Participants Gender
Male
Female