Gender differences in immune reconstitution: a multicentric cohort analysis in sub-Saharan Africa

In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution. Antiretroviral-naïve adults who received ART for at least 9 months in four HIV programs in s...

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Bibliographic Details
Published in:PloS one 2012-02, Vol.7 (2), p.e31078-e31078
Main Authors: Maman, David, Pujades-Rodriguez, Mar, Subtil, Fabien, Pinoges, Loretxu, McGuire, Megan, Ecochard, Rene, Etard, Jean-François
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
Adults
Africa South of the Sahara
AIDS
Analysis
Antiretroviral agents
Antiretroviral drugs
Antiretroviral therapy
Antiretroviral Therapy, Highly Active
CD4 antigen
CD4 Lymphocyte Count
Cohort analysis
Cohort Studies
Female
Gender aspects
Health aspects
HIV
HIV Infections - drug therapy
HIV Infections - immunology
Human immunodeficiency virus
Humans
Immune reconstitution
Immune response
Immune system
Life Sciences
Male
Mathematics
Medical research
Medicine
Men
Middle Aged
Morbidity
Mortality
Other
Patients
Risk factors
Sex Characteristics
Sex differences
Social and Behavioral Sciences
Time Factors
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Summary:In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution. Antiretroviral-naïve adults who received ART for at least 9 months in four HIV programs in sub-Saharan Africa were included. Multivariate mixed linear models were used to examine gender differences in immune reconstitution on first line ART. A total of 21,708 patients (68% women) contributed to 61,912 person-years of follow-up. At ART start,. Median CD4 at ART were 149 [IQR 85-206] for women and 125 cells/µL [IQR 63-187] for men. After the first year on ART, immune recovery was higher in women than in men, and gender-based differences increased by 20 CD4 cells/µL per year on average (95% CI 16-23; P250 cells/µL (difference between patients with 250 was 284 cells/µL; 95% CI 272-296; LR test for interaction with time p = 0.63). Among patients with initial CD4 count of 150-200 cells/µL, women reached 500 CD4 cells after 2.4 years on ART (95% CI 2.4-2.5) and men after 4.5 years (95% CI 4.1-4.8) of ART use. Women achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0031078