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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Sex differences in antiretroviral treatment outcomes among HIV-infected adults in an urban Tanzanian setting
AIDS, Volume 25, No. 9, Year 2011
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Description
Objective: To determine the relationship between sex and antiretroviral therapy (ART) outcomes in an urban Tanzanian setting. DESIGN:: Longitudinal analysis of a cohort of HIV-infected adult men and women on ART enrolled at the Management and Development for Health (MDH)-President's Emergency Plan For AIDS Relief (PEPFAR) HIV care and treatment program in Dar es Salaam, Tanzania. Methods: Clinical and immunologic responses to ART were compared between HIV-infected men and women enrolled from November 2004 to June 2008. Cox regression analyses were used to study sex differences with regard to mortality, immunologic failure (WHO, 2006) and loss to follow-up, after adjusting for other risk factors for the outcomes. Results: Four thousand, three hundred and eighty-three (34%) men and 8459 (66%) women were analyzed. Men were significantly more immunocompromised than women at enrollment in terms of stage IV disease (27 vs. 23%, P < 0.001) and mean CD4 cell count (123 vs. 136 cells/μl, P < 0.001). In multivariate analyses, men had a significantly higher risk of overall mortality [hazard ratio 1.19, 95% confidence interval (CI) 1.05-1.30, P < 0.001], immunologic nonresponse defined as CD4 cell count less than 100 cells/μl after at least 6 months of initiating ART (hazard ratio 1.74, 95% CI 1.44-2.11, P < 0.001) and loss to follow-up (hazard ratio 1.19, 95% CI 1.10-1.30, P < 0.001) than that in women. Associations did not change significantly when restricting analyses to the period of good adherence for all patients. Conclusion: Nonadherence to care and advanced immunodeficiency at enrollment explained only 17% of the inferior mortality in HIV-infected men in this resource-limited setting. Additional study of behavioral and biologic factors that may adversely impact treatment outcomes in men is needed to reduce these sex disparities. © 2011 Wolters Kluwer Health - Lippincott Williams & Wilkins.
Authors & Co-Authors
Hawkins, Claudia A.
United States, Evanston
Northwestern University
Tanzania, Dar es Salaam
Management and Development for Health
Chalamilla, Guerino E.
Tanzania, Dar es Salaam
Management and Development for Health
Okuma, James O.
Unknown Affiliation
Spiegelman, Donna L.
United States, Boston
Harvard T.h. Chan School of Public Health
Hertzmark, Ellen
Unknown Affiliation
Aris, Eric A.
Tanzania, Dar es Salaam
Management and Development for Health
Ewald, Tarcila
Tanzania, Dar es Salaam
Management and Development for Health
Mugusi, Ferdinand M.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Mtasiwa, Deo M.
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare
Fawzi, Wafaie W.
Tanzania, Dar es Salaam
Management and Development for Health
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 139
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1097/QAD.0b013e3283471deb
e-ISSN:
14735571
Research Areas
Environmental
Infectious Diseases
Study Design
Cohort Study
Study Locations
Tanzania
Participants Gender
Male
Female