Progression to AIDS and Death and Response to HAART in Men and Women from a Multicenter Hospital-Based Cohort

Pérez‐Hoyos, S.; Rodríguez-Arenas, M. Ángeles; Hera, Manuela García de la; Iribarren, José Antonio; Moreno, Santiago; Viciana, Pompeyo; Peña, Alejandro; Sirvent, José L. Gómez; Lacruz, J; Padilla, Sergio; Oteo, José A.; Asencio, R.; Amo, Julia del; CoRIS-MD,

doi:10.1089/jwh.2007.0437

Cited by 20 publications

(15 citation statements)

References 29 publications

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“…The observed differences in mortality on ART were interpreted as background differences in mortality between men and women unrelated to the HIV epidemic . In contrast, studies from high‐income countries with sufficient access to health care have shown that sex has no major impact on disease progression or mortality . In our study, mortality was still higher in men after adjusting for socio‐economic factors and baseline CD4 cell count, suggesting that advanced disease at enrolment alone could not explain the excess mortality in men.…”

Section: Discussioncontrasting

confidence: 73%

Differential effects of sex in a West African cohort of HIV‐1, HIV‐2 and HIV‐1/2 dually infected patients: men are worse off

Jespersen

Hønge

Esbjörnsson

et al. 2015

Tropical Med Int Health

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Abstractobjectives Several studies have reported conflicting effects of sex on HIV-1 infection. We describe differences in baseline characteristics and assess the impact of sex on HIV progression among patients at a clinic with many HIV-2 and HIV-1/2 dually infected patients.methods This study utilised a retrospective cohort of treatment-na€ ıve adults at the largest HIV clinic in Guinea-Bissau from 6 June 2005 to 1 December 2013. Baseline characteristics were assessed and the patients followed until death, transfer, loss to follow-up, or 1 June 2014. We estimated the time from the first clinic visit until initiation of ART, death or loss to follow-up using Cox proportional hazard models.results A total of 5694 patients were included in the study, 3702 women (65%) and 1992 men (35%). Women were more likely than men to be infected with HIV-2 (19% vs. 15%, P < 0.01) or dually infected with HIV-1/2 (11% vs. 9%, P = 0.02). For all HIV types, women were younger (median 35 vs. 40 years), less likely to have schooling (55% vs. 77%) or to be married (46% vs. 67%), and had higher baseline CD4 cell counts (median 214 vs. 178 cells/ll). Men had a higher ageadjusted mortality rate (hazard rate ratio (HRR) 1.29, 95% confidence interval (CI) 1.09-1.52) and were more often lost to follow-up (HRR 1.27, 95% CI 1.17-1.39).conclusion Significant differences exist between HIV-infected men and women regardless of HIV type. Men seek treatment at a later stage and, despite better socio-economic status, have higher mortality and loss to follow-up than women.

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Section: Discussioncontrasting

confidence: 73%

Differential effects of sex in a West African cohort of HIV‐1, HIV‐2 and HIV‐1/2 dually infected patients: men are worse off

Jespersen

Hønge

Esbjörnsson

et al. 2015

Tropical Med Int Health

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“…Inadequate care for knowledge about HIV/AIDS among the lower educational level groups may delay an AIDS diagnosis until symptoms appeared [45]. Reports of disparities in HIV survival related to sex have been mixed, with some studies reporting higher survival among female individuals [36], [46], some reporting it among male individuals [47], or no difference [38], [48], [49]. Consistent with a previous study [50], IDUs presented less likely to progress to AIDS following HIV diagnosis compared with MSMs, which might be related to the younger age of IDUs compared with that of MSMs.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Progression to AIDS and Death Following HIV Diagnosis: A Retrospective Cohort Study in Wuhan, China

et al. 2013

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ObjectiveTo identify determinants associated with disease progression and death following human immunodeficiency virus (HIV) diagnosis.MethodsDisease progression data from the diagnosis of HIV infection or acquiring immunodeficiency syndrome (AIDS) to February 29, 2012 were retrospectively collected from the national surveillance system databases and the national treatment database in Wuhan, China. Kaplan-Meier method, Logistic regression and Cox proportional hazards model were applied to identify the related factors of progression to AIDS or death following HIV diagnosis.ResultsBy the end of February 2012, 181 of 691 HIV infectors developed to AIDS, and 129 of 470 AIDS patients died among whom 289 cases received concurrent HIV/AIDS diagnosis. Compared with men infected through homosexual behavior, injection drug users possessed sharply decreased hazard ratio (HR) for progression to AIDS following HIV diagnosis [HR = 0.31, 95% confidence interval (CI), 0.18–0.54, P = 4.01×10−5]. HIV infectors at least 60 years presented 1.15-fold (HR = 2.15, 95% CI, 1.15–4.03, P = 0.017) increased risk to develop AIDS when compared with those aged 17–29 years. Similarly, AIDS patients with diagnosis ages between 50 and 59 years were at a 1.60-fold higher risk of death (HR = 2.60, 95% CI, 1.18–5.72, P = 0.017) compared to those aged 19–29 years. AIDS patients with more CD4+ T-cells within 6 months at diagnosis (cell/µL) presented lower risk of death (HR = 0.29 for 50- vs <50, 95% CI, 0.15–0.59, P = 0.001). The highly active antiretroviral therapy (HAART) delayed progression to AIDS from HIV diagnosis (HR = 0.15, 95% CI, 0.07–0.34, P = 6.46×10−6) and reduced the risk of death after AIDS diagnosis (HR = 0.02, 95% CI, 0.01–0.04, P = 7.25×10−25).ConclusionsProgression to AIDS and death following HIV diagnosis differed in age at diagnosis, transmission categories, CD4+ T-cell counts and HAART. Effective interventions should target those at higher risk for morbidity or mortality, ensuring early diagnosis and timely treatment to slow down the disease progression.

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“…Increased age and decreased educational level have been previously associated with increased mortality [22–24]. Reports of gender differences in HIV mortality have been mixed, with studies reporting higher male mortality [23], female mortality [25], or no difference [22, 26, 27]. Why single people are at higher risk and divorced or widowed people at lower risk of mortality compared to married people or people living together is not clear and may be related to the small numbers in each category.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Highly Active Antiretroviral Therapy on Mortality among HIV‐Infected Former Plasma Donors in China

Zhang

Dou²,

Lan³

et al. 2008

CLIN INFECT DIS

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Background In China, many former plasma donors (FPD) were infected with the human immunodeficiency virus (HIV) in the early-mid 1990s. Highly active antiretroviral therapy (HAART) was provided to FPDs beginning in 2002. The effect of HAART on mortality in this cohort has never been described. Methods Retrospective analysis of the national HIV epidemiology and treatment databases, from 1993–2006. All HIV-infected subjects from ten high HIV prevalence counties in six provinces were eligible. Inclusion criteria were: 1) plasma donation history, 2) Western blot positive, 3) clinical diagnosis of AIDS or CD4+ cell count <200/μl at any time, and 4) age ≥18 at AIDS diagnosis. Results Of 9059 eligible subjects, 4093 met the inclusion criteria. Mean age was 41 years, 51% were male, 99% were farmers, and 87% were from Henan Province. Overall mortality declined from 27.3/100 person-years in 2001 to 4.6/100 person-years in 2006. Conversely, the proportion of AIDS patient-years on HAART increased from 0% in 2001 to 70.5% in 2006. In a multivariate Cox proportional hazards analysis, the greatest risk factor for mortality was not receiving HAART, with a hazard ratio 2.8, 95% confidence interval 2.4–3.3. Among treated patients, those initiating therapy with lower CD4+ cell counts and higher numbers of opportunistic infections were at greater risk of death. Conclusions The national treatment program has significantly reduced the mortality rate among HIV-infected FPDs through the use of generic drugs in a rural treatment setting with limited laboratory monitoring. Treatment success can be improved through increased coverage and earlier initiation of therapy.

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Progression to AIDS and Death and Response to HAART in Men and Women from a Multicenter Hospital-Based Cohort

Abstract: We have found no differences in HIV progression and response to HAART attributable to gender among patients accessing the Spanish hospital network.

Cited by 20 publications

References 29 publications

Differential effects of sex in a West African cohort of HIV‐1, HIV‐2 and HIV‐1/2 dually infected patients: men are worse off

Differential effects of sex in a West African cohort of HIV‐1, HIV‐2 and HIV‐1/2 dually infected patients: men are worse off

Determinants of Progression to AIDS and Death Following HIV Diagnosis: A Retrospective Cohort Study in Wuhan, China

The Effect of Highly Active Antiretroviral Therapy on Mortality among HIV‐Infected Former Plasma Donors in China

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