Ten‐year attrition and antiretroviral therapy response among HIV‐positive adults: a sex‐based cohort analysis from eight West African countries

Abstract

Introduction: Sex differences have already been reported in sub-Saharan Africa for attrition and immunological response after antiretroviral therapy (ART) initiation, but follow-up was usually limited to the first two to three years after ART initiation. We evaluated sex differences on the same outcomes in the 10 years following ART initiation in West African adults. Methods: We used cohort data of patients included in the IeDEA West Africa collaboration, who initiated ART between 2002 and 2014. We modelled no-follow-up and 10-year attrition risks, and immunological response by sex using logistic regression analysis, survival analysis with random effect and linear mixed models respectively. Results: A total of 71,283 patients (65.8% women) contributed to 310,007 person-years of follow-up in 16 clinics in eight West African countries. The cumulative attrition incidence at 10-year after ART initiation reached 75% and 68% for men and women respectively. Being male was associated with an increased risk of no follow-up after starting ART (5.1% vs. 4.0%, adjusted Odds Ratio: 1.25 [95% CI: 1.15 to 1.35]) and of 10-year attrition throughout the 10-year period following ART initiation: adjusted Hazard Ratios were 1.22 [95% CI: 1.17 to 1.27], 1.08 [95% CI: 1.04 to 1.12] and 1.04 [95% CI: 1.01 to 1.08] during year 1, years 2 to 4 and 5 to 10 respectively. A better immunological response was achieved by women than men: monthly CD4 gain was 30.2 and 28.3 cells/mL in the first four months and 2.6 and 1.9 cells/lL thereafter. Ultimately, women reached the average threshold of 500 CD4 cells/lL in their sixth year of follow-up, whereas men failed to reach it even at the end of the 10-year follow-up period. The proportion of patients reaching the threshold was much higher in women than in men after 10 years since ART initiation (65% vs. 44%). Conclusions: In West Africa, attrition is unacceptably high in both sexes. Men are more vulnerable than women on both attrition and immunological response to ART in the 10 years following ART initiation. Innovative tracing strategies that are sexadapted are needed for patients in care to monitor attrition, detect early high-risk groups so that they can stay in care with a durably controlled infection.

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

“…Furthermore, this study suggested that male patients have higher risk of poor immune reconstitution and mortality than females, which may be traced back to differences in life customs, metabolism and adherence between males and females [36,37]. Kroeze et al[38] corroborated the above literature data.…”

A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar

“…As the period considered in our cohort study ended a few months after the implementation of the “Treat all” strategy in Madagascar, the impact of this strategy on attrition from care remains unclear. Furthermore, long-term retention in care remains a challenge, with a cumulative incidence of attrition from care of up to 75% 10 years after ART initiation among adult PLHIV in a study in Africa ( 31 ).…”

“…A total of 490 PLHIV were included in the analysis; 67.1% (n = 329) were men. The median age (IQR) at enrollment in care was 29 years (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). We did not find any differences in age at enrollment in care between male and female PLHIV, with a median age (IQR) of 30 years (24-37) vs. 28 years (25-38) (p = 0.552), respectively.…”

Incomplete immune reconstitution and its predictors in people living with HIV in Wuhan, China

“…This is common with the finding of other studies, this may be due to the fact that female patients receive HAART at an early stage, reducing the incidence of opportunistic infections as well as achieving rapid CD4 cell recovery. In addition, traced back to differences in life customs, metabolism and adherence between males and females [ 38 , 39 ]. Kroeze et al [ 40 ] corroborated the above literature data.…”