Abstract
BackgroundIn 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 FindingsAntiretroviral-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.ConclusionWomen achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men.
Highlights
According to UNAIDS, more than 3.9 million patients were receiving antiretroviral therapy (ART) in sub-Saharan Africa at the end of 2009
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
This study explored gender differences in immune reconstitution after the first 9 months of ART, to focus on the second phase of immune reconstitution, in four sub-Saharan African HIV programs supported by Medecins Sans Frontieres (MSF)
Summary
According to UNAIDS, more than 3.9 million patients were receiving antiretroviral therapy (ART) in sub-Saharan Africa at the end of 2009. This represents 37% of those in need of treatment and an increase of one million patients in one year [1]. Immune recovery after ART initiation follows two phases: a rapid increase during the first months, followed by a slower one thereafter [7,8,9] They correspond to different biological mechanisms: the first phase of rapid CD4 cell increase is linked to the relapse of pre-trapped CD4 cells [10], while the second phase corresponds to a proliferation of new CD4 cells, related to thymus reactivation, which progressively reconstitutes stocks of CD4 cells [11].
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have