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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Gender differences in HIV disease progression and treatment outcomes among HIV patients one year after starting antiretroviral treatment (ART) in Dar es Salaam, Tanzania
BMC Public Health, Volume 13, No. 1, Article 38, Year 2013
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Description
Background: We investigated gender differences in treatment outcome during first line antiretroviral treatment (ART) in a hospital setting in Tanzania, assessing clinical, social demographic, virological and immunological factors. Methods. We conducted a cohort study involving HIV infected patients scheduled to start ART and followed up to 1 year on ART. Structured questionnaires and patients file review were used to collect information and blood was collected for CD4 and viral load testing. Gender differences were assessed using Kruskal-Wallis test and chi-square test for continuous and categorical data respectively. Survival distributions for male and female patients were estimated using the Kaplan-Meier method and compared using Cox proportional hazards models. Results: Of 234 patients recruited in this study, 70% were females. At baseline, women had significantly lower education level; lower monthly income, lower knowledge on ARV, less advanced HIV disease (33% women; 47% men started ART at WHO stage IV, p = 0.04), higher CD4 cell count (median 149 for women, 102 for men, p = 0.02) and higher BMI (p = 0.002). After 1 year of standard ART, a higher proportion of females survived although this was not significant, a significantly higher proportion of females had undetectable plasma viral load (69% women, 45% men, p = 0.003), however females ended at a comparable CD4 cell count (median CD4, 312 women; 321 men) signifying a worse CD4 cell increase (p = 0.05), even though they still had a higher BMI (p = 0.02). The unadjusted relative hazard for death for men compared to women was 1.94. After correcting for confounding factors, the Cox proportional hazards showed no significant difference in the survival rate (relative hazard 1.02). Conclusion: We observed women were starting treatment at a less advanced disease stage, but they had a lower socioeconomical status. After one year, both men and women had similar clinical and immunological conditions. It is not clear why women lose their immunological advantage over men despite a better virological treatment response. We recommend continuous follow up of this and more cohorts of patients to better understand the underlying causes for these differences and whether this will translate also in longer term differences. © 2013 Mosha et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Mosha, Fausta Shakiwa
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare
Belgium, Leuven
Rega Institute for Medical Research
Muchunguzi, Victor
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare
Matee, Mecky Isaac N.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Sangeda, Raphael Zozimus
Belgium, Leuven
Rega Institute for Medical Research
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Vercauteren, Jurgen
Belgium, Leuven
Rega Institute for Medical Research
Nsubuga, Peter
United States, Atlanta
Global Public Health Solutions
Lyamuya, Eligius Francis
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Vandamme, Anne Mieke
Belgium, Leuven
Rega Institute for Medical Research
Portugal, Lisbon
Instituto de Higiene e Medicina Tropical
Statistics
Citations: 63
Authors: 8
Affiliations: 5
Identifiers
Doi:
10.1186/1471-2458-13-38
e-ISSN:
14712458
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Tanzania
Participants Gender
Male
Female