Maman, D;
Pujades-Rodriguez, M;
Subtil, F;
Pinoges, L;
McGuire, M;
Ecochard, R;
Etard, JF;
(2012)
Gender differences in immune reconstitution: a multicentric cohort analysis in sub-Saharan Africa.
PLoS One
, 7
(2)
, Article e31078. 10.1371/journal.pone.0031078.
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Abstract
Background 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. Methods/Principal Findings 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; P<0.001). Up to 6 years after ART start, patients with low initial CD4 levels experienced similar gains compared to patients with high initial levels, including those with CD4>250cells/µL (difference between patients with <50 cells/µL and those 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. Conclusion 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.
| Type: | Article |
|---|---|
| Title: | Gender differences in immune reconstitution: a multicentric cohort analysis in sub-Saharan Africa |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1371/journal.pone.0031078 |
| Publisher version: | http://dx.doi.org/10.1371/journal.pone.0031078 |
| Language: | English |
| Additional information: | © 2012 Maman et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. PMCID: PMC3281917 |
| Keywords: | Adult, Africa South of the Sahara, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Cohort Studies, Female, HIV Infections, Humans, Male, Middle Aged, Sex Characteristics, Time Factors |
| UCL classification: | UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1399555 |
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