Women experience a better long-term immune recovery and a better survival on HAART in Lao People’s Democratic Republic

Abstract

BackgroundIn April 2003, Médecins Sans Frontières launched an HIV/AIDS programme to provide free HAART to HIV-infected patients in Laos. Although HIV prevalence is estimated as low in this country, it has been increasing in the last years. This work reports the first results of an observational cohort study and it aims to identify the principal determinants of the CD4 cells evolution and to assess mortality among patients on HAART.MethodsWe performed a retrospective database analysis on patients initiated on HAART between 2003 and 2009 (CD4<200cells/μL or WHO stage 4). We excluded from the analysis patients who were less than 16 years old and pregnant women. To explore the determinants of the CD4 reconstitution, a linear mixed model was adjusted. To identify typical trajectories of the CD4 cells, a latent trajectory analysis was carried out. Finally, a Cox proportional-hazards model was used to reveal predictors of mortality on HAART including appointment delay greater than 1 day.ResultsA total of 1365 patients entered the programme and 913 (66.9%) received an HAART with a median CD4 of 49 cells/μL [IQR 15–148]. High baseline CD4 cell count and female gender were associated with a higher CD4 level over time. In addition, this gender difference increased over time. Two typical latent CD4 trajectories were revealed showing that 31% of women against 22% of men followed a high CD4 trajectory. In the long-term, women were more likely to attend appointments without delay. Mortality reached 6.2% (95% CI 4.8-8.0%) at 4 months and 9.1% (95% CI 7.3-11.3%) at 1 year. Female gender (HR=0.17, 95% CI 0.07-0.44) and high CD4 trajectory (HR=0.19, 95% CI 0.08-0.47) were independently associated with a lower death rate.ConclusionsPatients who initiated HAART were severely immunocompromised yielding to a high early mortality. In the long-term on HAART, women achieved a better CD4 cells reconstitution than men and were less likely to die. This study highlights important differences between men and women regarding response to HAART and medical care, and questions men’s compliance to treatment.

Impact of Age and Sex on CD4+ Cell Count Trajectories following Treatment Initiation: An Analysis of the Tanzanian HIV Treatment Database

“…Several modeling strategies have been utilized to more rigorously describe CD4+ cell count recovery trajectories following ART initiation. Some have used linear mixed effects models[ 21 – 24 ], which have the drawback of enforcing a linear trend on every individual’s CD4+ cell count trajectory. Additional linear models include spline terms to account for changing slope over time[ 15 , 25 ], including hierarchical Bayesian change-point models[ 26 ].…”

Epidemiology of ocular surface squamous neoplasia in Africa

“… 2011 ; Bastard et al . 2013 ). In Europe, the response to ART and mortality is similar for both sexes (Perez-Molina et al .…”

CD4 Response Up to 5 Years After Combination Antiretroviral Therapy in Human Immunodeficiency Virus-Infected Patients in Latin America and the Caribbean

“…To date, several studies have reported that the strongest predictor of long-term CD4 response is baseline CD4, even among patients with long-term HIV RNA suppression [ 8 , 11 ]. In addition, studies have found that women [ 12 ] and patients initiating treatment at younger ages [ 13 ] show better CD4 response, whereas specific cART regimens have not been shown to significantly impact long-term immune response [ 14 ]. Our results corroborate these findings.…”