Lars Jørgen Østergaard

Differential effects of sex in a West African cohort of HIV-1, HIV-2, and HIV-1/2 infected patients: Men are worse off

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OBJECTIVES: Several studies have reported conflicting effects of sex on HIV-1 infection. We describe differences in baseline characteristics and assess the impact of sex on HIV progression among patients at a clinic with many HIV-2 and dually infected patients.

METHODS: The study utilized a retrospective cohort of treatment-naïve adults at the largest HIV clinic in Guinea-Bissau from June 6, 2005, to December 1, 2013. Baseline characteristics were assessed and the patients followed until death, transfer, loss to follow-up, or June 1, 2014. We estimated the time from the first clinic visit until initiation of ART, death, or loss to follow-up using Cox proportional hazard models.

RESULTS: A total of 5,694 patients were included in the study, 3,702 women (65%) and 1,992 men (35%). Women were more likely than men to be infected with HIV-2 (19% vs. 15%, p<0.01) or dually infected with HIV-1/2 (11% vs. 9%, p=0.02). For all HIV types, women were younger (median 35 vs. 40 years), less likely to have schooling (55% vs. 77%) or to be married (46% vs. 67%), and had higher baseline CD4 cell counts (median 214 vs. 178 cells/μl). Men had a higher age-adjusted mortality rate (hazard rate ratio (HRR) 1.29, 95% confidence interval (CI) 1.09-1.52) and were more often lost to follow-up (HRR 1.27, 95% CI 1.17-1.39).

CONCLUSION: Significant differences exist between HIV-infected men and women regardless of HIV type. Men seek treatment at a later stage and, despite better socioeconomic status, have higher mortality and loss to follow-up than women. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalTropical Medicine & International Health
Pages (from-to)253-262
Publication statusPublished - 2016

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