Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi

Abstract

Summaryobjective To investigate the effect of gender on mortality of HIV-infected adults receiving antiretroviral therapy (ART) and its possible reasons. results Over the study period, 2838 adult AIDS patients received ART. Of these, 2029 (71.5%) were alive and still on ART, 376 (13.2%) were dead and 433 (15.3%) were lost to follow-up. Survival analysis with Kaplan-Meier estimator showed significantly higher survival rates among females than males in WHO stage 1, 2 and 3 (both P < 0.0001) and borderline in stage 4 (P = 0.076). The Cox model revealed a death hazard ratio (males vs. females) of 1.70 (95% confidence interval 1.35-2.15) after controlling for WHO clinical stages, body mass index and age. More men than women were lost to follow-up in all occupations except health workers.conclusions The most important reasons for a higher mortality in male patients starting ART may relate to their seeking medical care at a more advanced stage of immunodeficiency and poorer compliance with therapy. The issue needs to be addressed in scaling up ART programmes in Africa.

Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya

“…Similarly, men who attended one or more follow-up visits were most likely to be lost to follow-up if they had advanced-stage disease at enrolment or had not received cART, which makes it highly likely that they were lost to follow-up because they died. 12,[16][17][18] These findings are consistent with those of other studies which report that HIV-infected men present later for care than women and are therefore at greater risk of an adverse clinical outcome. 7,9,10 In contrast, women may have delayed returning to care when their own health was relatively stable because of personal commitments, notably family commitments.…”

Patient retention and attrition on antiretroviral treatment at district level in rural Malawi

“…19 This issue also needs to be more actively addressed in the scaling-up process through targeted information and education sessions as well as targeted counselling.…”

Gender differences in retention and survival on antiretroviral therapy of HIV-1 infected adults in Malawi

“…Since the advent of ART, mortality rates for people living with HIV/AIDS have decreased substantially both in resourcerich 1,2 and resource-limited settings 3,8 with conflicting reports about gender-related differences in mortality [9][10][11][12][13][14][15][16] . Where differences have been reported, little is known about the reasons.…”