In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution

AS Muula

B Bila

C Hawkins

CF Kelley

CJ Smith

D Nash

David Maman

DC Douek

DK Ekouevi

E Florence

E Nicastri

F Garcia

Fabien Subtil

G Casella

GR Kaufmann

IM Kigozi

JA Sterne

Jean-François Etard

JV Baker

K Falster

L Ferradini

L Teixeira

Landon Myer

Loretxu Pinoges

M Cornell

M May

M Pujades-Rodriguez

Mar Pujades-Rodriguez

Megan McGuire

MM Kitahata

NG Pakker

NJ Olsen

NM Laird

P Braitstein

P De Beaudrap

P Severe

PW Hunt

RD Moore

RE Barth

Rene Ecochard

RK Lodwick

RP Bucy

S Boyer

S Emery

S Rabe-Hesketh

SD Lawn

TP Giordano

Z Dou

English

PubMed

Maman, David

Pujades-Rodriguez, Mar

Subtil, Fabien

Pinoges, Loretxu

McGuire, Megan

Ecochard, Rene

Etard, Jean-François

MSF Field Research

Calmy A

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Modeling CD4+ cell count increase over a six-year period in HIV-1-infected patients on highly active antiretroviral therapy in Senegal.

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Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment.

Skrondal A

The impact of gender and income on survival and retention in a South African antiretroviral therapy programme.

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World Health Organization

Gender differences in immune reconstitution: a multicentric cohort analysis in sub-saharan Africa

Background: In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution.Methods/Principal Findings: Antiretroviral-naive adults who received ART for at least 9 months in four HIV programs in sub-Saharan Africa were included. Multivariate mixed linear models were used to examine gender differences in immune reconstitution on first line ART. A total of 21,708 patients (68% women) contributed to 61,912 person-years of follow-up. At ART start,. Median CD4 at ART were 149 [IQR 85-206] for women and 125 cells/mu L [IQR 63-187] for men. After the first year on ART, immune recovery was higher in women than in men, and gender-based differences increased by 20 CD4 cells/mu L per year on average (95% CI 16-23; P250cells/mu L (difference between patients with 250 was 284 cells/mu L; 95% CI 272-296; LR test for interaction with time p = 0.63). Among patients with initial CD4 count of 150-200 cells/mu L, women reached 500 CD4 cells after 2.4 years on ART (95% CI 2.4-2.5) and men after 4.5 years (95% CI 4.1-4.8) of ART use.Conclusion: Women achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men

Maman, D.

Pujades-Rodriguez, M.

Subtil, F.

Pinoges, L.

Mcguire, M.

Ecochard, R.

Etard, J.F.

Hal-Diderot

Gender Differences in Immune Reconstitution: A Multicentric Cohort Analysis in Sub-Saharan Africa

In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution. = 0.63). Among patients with initial CD4 count of 150–200 cells/µL, women reached 500 CD4 cells after 2.4 years on ART (95% CI 2.4–2.5) and men after 4.5 years (95% CI 4.1–4.8) of ART use.Women achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men

Maman David

Pujades-Rodriguez Mar

Subtil Fabien

Pinoges Loretxu

McGuire Megan

Ecochard Rene

Etard Jean-François

Public Library of Science (PLOS)

HAL-HCL

Background



In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution.

Methods/Principal Findings



Antiretroviral-naïve adults who received ART for at least 9 months in four HIV programs in sub-Saharan Africa were included. Multivariate mixed linear models were used to examine gender differences in immune reconstitution on first line ART.



A total of 21,708 patients (68% women) contributed to 61,912 person-years of follow-up. At ART start,. Median CD4 at ART were 149 [IQR 85–206] for women and 125 cells/µL [IQR 63–187] for men. After the first year on ART, immune recovery was higher in women than in men, and gender-based differences increased by 20 CD4 cells/µL per year on average (95% CI 16–23; P250cells/µL (difference between patients with 250 was 284 cells/µL; 95% CI 272–296; LR test for interaction with time p = 0.63). Among patients with initial CD4 count of 150–200 cells/µL, women reached 500 CD4 cells after 2.4 years on ART (95% CI 2.4–2.5) and men after 4.5 years (95% CI 4.1–4.8) of ART use.

Conclusion



Women achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men

Maman, D

Pujades-Rodriguez, M

Subtil, F

Pinoges, L

McGuire, M

Ecochard, R

Etard, JF

UCL Discovery

Gender differences in immune reconstitution: a multicentric cohort analysis in sub-Saharan Africa

Background: In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution. Methods/Principal Findings: Antiretroviral-naive adults who received ART for at least 9 months in four HIV programs in sub-Saharan Africa were included. Multivariate mixed linear models were used to examine gender differences in immune reconstitution on first line ART. A total of 21,708 patients (68% women) contributed to 61,912 person-years of follow-up. At ART start,. Median CD4 at ART were 149 &#91;IQR 85-206&#93; for women and 125 cells/mu L &#91;IQR 63-187&#93; for men. After the first year on ART, immune recovery was higher in women than in men, and gender-based differences increased by 20 CD4 cells/mu L per year on average (95% CI 16-23; P<0.001). Up to 6 years after ART start, patients with low initial CD4 levels experienced similar gains compared to patients with high initial levels, including those with CD4>250cells/mu L (difference between patients with <50 cells/mu L and those with >250 was 284 cells/mu L; 95% CI 272-296; LR test for interaction with time p = 0.63). Among patients with initial CD4 count of 150-200 cells/mu L, women reached 500 CD4 cells after 2.4 years on ART (95% CI 2.4-2.5) and men after 4.5 years (95% CI 4.1-4.8) of ART use. Conclusion: Women achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men

McGuire, M.

Name not available

Gender differences in immune reconstitution : a multicentric cohort analysis in Sub-Saharan Africa

BACKGROUND: In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution. METHODS/PRINCIPAL FINDINGS: Antiretroviral-naïve adults who received ART for at least 9 months in four HIV programs in sub-Saharan Africa were included. Multivariate mixed linear models were used to examine gender differences in immune reconstitution on first line ART. A total of 21,708 patients (68% women) contributed to 61,912 person-years of follow-up. At ART start,. Median CD4 at ART were 149 [IQR 85-206] for women and 125 cells/µL [IQR 63-187] for men. After the first year on ART, immune recovery was higher in women than in men, and gender-based differences increased by 20 CD4 cells/µL per year on average (95% CI 16-23; P250 cells/µL (difference between patients with 250 was 284 cells/µL; 95% CI 272-296; LR test for interaction with time p = 0.63). Among patients with initial CD4 count of 150-200 cells/µL, women reached 500 CD4 cells after 2.4 years on ART (95% CI 2.4-2.5) and men after 4.5 years (95% CI 4.1-4.8) of ART use. CONCLUSION: Women achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men

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PLoS ONE

Gender differences in immune reconstitution: a multicentric cohort analysis in sub-Saharan Africa.

Gender Differences in Immune Reconstitution: A Multicentric Cohort Analysis in Sub-Saharan Africa

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