The vulnerability of men to virologic failure during antiretroviral therapy in a public routine clinic in Burkina Faso

Abstract

IntroductionGender differences in antiretroviral therapy (ART) outcomes are critical in sub-Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso.MethodsWe performed a case-control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV-1 or HIV-1+2, and on first-line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads <300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART.ResultsOf 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viro-immunologic failure, and four (2.3%) had viro-clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p<0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor-based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77–3.60; p<0.001).ConclusionsMen on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting.

Heterogeneity of virological suppression in the national antiretroviral programme of Cameroon (ANRS 12288 EVOLCAM)

“…Taking advantage of this situation, we assessed the impact of older age on virological suppression and found that being ≥ 50 years of age was significantly associated with a better virological outcome (aOR 1.74; 95% CI 1.20–2.53; P = 0.003). This result is in line with previous studies using age either as a continuous variable or as a categorical variable with lower thresholds . The better virological outcome in older patients on ART might be linked to improved socioeconomic and psychological status.…”

“…20-2.53; P = 0.003). This result is in line with previous studies using age either as a continuous variable or as a categorical variable with lower thresholds [13][14][15][16]. The better virological outcome in older patients on ART might be linked to improved socioeconomic and psychological status.…”

Factors Associated with Adverse Therapeutic Outcomes in People Living with HIV (PLHIV) Monitored in Roi Baudouin Health Care Center, Dakar, Senegal

“…Virological failure in our series was 19%. This prevalence is like the one described by Boender (20) in countries with limited resources, and lower than those described in the sub-region precisely in Togo [21] and Burkina-Faso [22].…”

HIV-Positive Men's Experiences with Integrated Family Planning and HIV Services in Western Kenya: Integration Fosters Male Involvement

“…17,18 Given the men's strong preference for HIV clinics as their source of FP services, we argue that integrating FP services into HIV clinics should be kept a priority as this model likely fosters male involvement in FP, which, in turn, may improve contraceptive use. 29 In addition, HIVpositive men in SSA tend to have worse clinical outcomes as compared to women [39][40][41][42][43][44][45] and face unique challenges in accessing and remaining in HIV care and treatment, [46][47][48][49][50] and integrated FP services may serve as one of many tools to attract and retain these men.…”