High mortality rates in men initiated on anti-retroviral treatment in KwaZulu-Natal, South Africa.

Kogieleum Naidoo,Rochelle Nicola Adams,Aveshen Govender,Quarraisha Abdool-Karim,Tilagavathy Chinappa,Razia Hassan-Moosa,Salim Abdool-Karim,Nesri Padayatchi,Nonhlanhla Yende-Zuma,Halima Dawood,Dhineshree Govender

doi:10.1371/journal.pone.0184124

Abstract

In attaining UNAIDS targets of 90-90-90 to achieve epidemic control, understanding who the current utilizers of HIV treatment services are will inform efforts aimed at reaching those not being reached. A retrospective chart review of CAPRISA AIDS Treatment Program (CAT) patients between 2004 and 2013 was undertaken. Of the 4043 HIV-infected patients initiated on ART, 2586 (64.0%) were women. At ART initiation, men, compared to women, had significantly lower median CD4+ cell counts (113 vs 131 cells/mm3, p <0.001), lower median body mass index (BMI) (21.0 vs 24.2 kg/m2, p<0.001), higher mean log viral load (5.0 vs 4.9 copies/ml, p<0.001) and were significantly older (median age: 35 vs. 32 years, p<0.001). Men had higher mortality rates compared to women, 6.7 per 100 person-years (p-y), (95% CI: 5.8–7.8) vs. 4.4 per 100 p-y, (95% CI: 3.8–5.0); mortality rate ratio: 1.54, (95% CI: 1.27–1.87), p <0.001. Age-standardised mortality rate was 7.9 per 100 p-y (95% CI: 4.1–11.7) for men and 5.7 per 100 p-y (95% CI: 2.7 to 8.6) for women (standardised mortality ratio: 1.38 (1.15 to 1.70)). Mean CD4+ cell count increases post-ART initiation were lower in men at all follow-up time points. Men presented later in the course of their HIV disease for ART initiation with more advanced disease and experienced a higher mortality rate compared to women.

Highlights

In South Africa, an estimated 6.2 million people are currently living with HIV infection [1]
We found that the attributable risk of death among patients initiating anti-retroviral therapy (ART) was 24.3% for patients with a low baseline CD4+ cell count and 10.2% for male patients (Table 4)
While heterosexual transmission is the primary mode of HIV transmission in sub Saharan Africa, the impact of free ART provision on access and clinical outcomes in men and women is unequal

Summary

Introduction

In South Africa, an estimated 6.2 million people are currently living with HIV infection [1]. South Africa has been successful in implementing the largest anti-retroviral programme in the world with more than 3 million HIV infected people currently on treatment [2]. High HIV incidence rates continue to occur, and HIV related morbidity and mortality dominates as the main cause of hospitalization and premature death for the last 2 decades [3]. High mortality rates in men initiated on ART. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Objectives

Methods

Results

Discussion

Conclusion