Gender difference in advanced HIV disease and late presentation according to European consensus definitions

Abstract

Effectiveness of highly active antiretroviral therapy is limited for a large proportion of individuals living with HIV presenting for medical care at an advanced stage. Controversial results of gender differences in risk of late HIV diagnosis were reported among existing literatures. Therefore, we conducted this meta-analysis to synthesize a summary of gender differences in risk of advanced HIV disease (AHD) and late presentation (LP) according to European consensus definitions. Totally, 32 studies were included based on predetermined selection criteria. The pooled adjusted odds ratios of males presenting with AHD and LP compared with females were 1.73 (95% confidence interval [CI], 1.59–1.89) and 1.38 (95% CI, 1.18–1.62) with significant heterogeneity observed (I2 = 78.50%, and I2 = 85.60%, respectively). Subgroup analysis revealed that time lag, study location, number of patients, proportion of females, study design, number of adjusted variables might be potential source of heterogeneity. Sensitivity analysis showed robustness of the results. No publication bias was observed in studies on AHD or LP. The current meta-analysis indicated that males are at higher risk of AHD or LP compared with females. More attention should be paid to males to make sure early testing, diagnosis, and treatment, and ultimately improve individual and population health.

Late diagnosis, delayed presentation and late presentation among persons enrolled in a clinical HIV cohort in Ontario, Canada (1999–2013)

“…Despite evidence of earlier diagnosis, people who had ever injected drugs were more likely to delay presentation in our study and less likely to be engaged in later steps of the cascade in another analysis of the OCS . In contrast to findings from a recent meta‐analysis of 32 studies world‐wide , we identified a higher prevalence of late diagnosis and presentation among females. This difference may be attributable to variations in the epidemic across populations and geographies .…”

Prevalence and Risk Factors of Mortality among Adult HIV Patients Initiating ART in Rural Setting of HIV Care and Treatment Services in North Western Tanzania: A Retrospective Cohort Study

“…With this background, one study from China indicated that male patients were 1.73 times more likely to present with advanced HIV diagnosis than female patients [31], similar to a study from Nigeria, where male patients were 1.8 times more likely to present with advanced HIV diagnosis [32]. Also another study assessing mortality in Uganda had indicated that male patients were more severely ill with most of WHO clinical stages 3 and 4 AIDS-defining illnesses (36% versus 33%, p < 0.0001) and they had 37% more risk of death compared to female patients on receipt of ART (OR = 1.37, p < 0.001) [12].…”

Epstein-Barr virus infection and oral squamous cell carcinoma risk: A meta-analysis

“…Nevertheless, a few limitations should be noted. First, high heterogeneity was shown in overall and subgroup analyses, which might add some uncertainty about the magnitude of the conclusion [ 45 , 46 ], and should be taken into consideration when interpreted the results. Second, all the included studies were published in English or Chinese, possibly leading to a language bias, although some previous studies suggested that it did not appear to influence the results [ 47 , 48 ].…”

“…Third, there is a concern regarding the potential risk bias. All included studies were retrospective studies, and the integrity of original data and potential recall bias might affect the results [ 45 ]. Fourth, the included studies were small-scale case control studies with small sample size, which might lower the precision of the results.…”