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

Abstract

Abstractobjectives 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 HIV-1/2 dually infected patients.methods This study utilised a retrospective cohort of treatment-na€ ıve adults at the largest HIV clinic in Guinea-Bissau from 6 June 2005 to 1 December 2013. Baseline characteristics were assessed and the patients followed until death, transfer, loss to follow-up, or 1 June 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 5694 patients were included in the study, 3702 women (65%) and 1992 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/ll). Men had a higher ageadjusted 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 socio-economic status, have higher mortality and loss to follow-up than women.

Effect of sex and age on outcomes among HIV-2-infected patients starting antiretroviral therapy in West Africa

“…Age is another cofactor frequently cited to explain the difference in mortality among ART-receiving men and women. Many surveys identified the older age of men compared with women at ART initiation, as a reason for sex-difference in mortality (9,13,14,30). In our cohort, more men than women initiated ART after the age of 50 and this age difference could also partly explain the difference in mortality between men and women.…”

“…In resource-limited settings, higher mortality (12–14) and loss to follow-up (LTFU) rates have been reported in men than in women among HIV-1 infected individuals (9,15–17), as well as an association between LTFU and mortality (18). Many possible explanations such as baseline characteristics (19,20), late presentation (79% of HIV-1 infected individuals initiating ART with CD4 count <200/mm 3 ), high viral load (> 5 log) and suboptimal immunologic response (14,21) have been suggested, but the underlying causes of these findings remain poorly understood.…”

Mortality and survival patterns of people living with HIV-2

“…In the Gambia, Peterson and colleagues identified CD4 cell count <50 per μl (aHR = 2.3; CI: 1.2–4.5] p=0.02), haemoglobin level <8.0g/dl (aHR: 6.2; CI: 2.8–13.8; p<0.001), weight <45kg (aHR: 3.9; CI: 1.8–8.2; p<0.001) and male gender (aHR: 4.9; CI: 2.5–10.8; p<0.001) as factors associated with mortality among people living with HIV-2 and receiving ART (38). Finally, mortality in people living with HIV-2 either ART naïve and on ART seems to be associated to the same factors than in HIV-1 mortality, including age, sex, clinical and laboratorial baseline characteristics (38,39,42,43). However, the role of immune activation in the mortality and sex difference among HIV-2 infected individuals remain unclear and further investigation are needed (44).…”

Delayed disease progression in HIV-2: the importance of TRIM5α and the retroviral capsid

“…Being male is an important determining factor in disease outcomes for both HIV-1 and HIV-2 [90]. These findings may be explained, in part, by the social behaviour of men resulting in poor adherence to ART and health-seeking behaviour later in infection [91].…”