Cornell Morna, Myer Landon, Kaplan Richard, Bekker Linda-Gail, Wood Robin
University of Cape Town, South Africa.
Trop Med Int Health. 2009 Jul;14(7):722-31. doi: 10.1111/j.1365-3156.2009.02290.x. Epub 2009 Apr 27.
Despite the rapid expansion of antiretroviral therapy (ART) services in Africa, there are few data on whether outcomes differ for women and men and what factors may drive such variation. We investigated the association of gender and income with survival and retention in a South African ART programme.
A total of 2196 treatment-naïve adults were followed for 1 year on ART. Proportional hazards regression was used to explore associations between baseline characteristics and survival and loss-to-follow-up (LTFU).
Patients were predominantly female (67%). Men presented at an older age and with more advanced HIV disease, and during early ART the crude death rate was higher among men than women (22.8 vs 12.5/100 person-years; P = 0.002). However in multivariate analysis, gender was not significantly associated with survival after adjusting for baseline clinical and immunovirological status (HR = 1.46, 95% CI = 0.96-2.22; P = 0.076). In late ART (4-12 months), there was no gender difference in mortality rates (3.5 vs 3.8/100 person-years; P = 0.817). In multivariate analysis, survival was strongly associated with age (HR = 1.05, 95% CI = 1.02-1.09; P < 0.001), CD4 count >150 vs <50 cells/microl (HR = 0.35, 95% CI = 0.14-0.87; P = 0.023) and any monthly income vs none (HR = 0.47, 95% CI = 0.25-0.88; P = 0.018). Having some monthly income was protective against LTFU at 1 year on ART (adjusted HR = 0.56, 95% CI = 0.39-0.82; P = 0.002).
Men's high early mortality on ART appears due largely to their presentation with more advanced HIV disease. Efforts are needed to enroll men into care earlier in HIV disease and to reduce socio-economic inequalities in ART programme outcomes.
尽管抗逆转录病毒疗法（ART）服务在非洲迅速扩展，但关于男性和女性的治疗结果是否存在差异以及哪些因素可能导致这种差异的数据却很少。我们调查了南非ART项目中性别和收入与生存及治疗留存率之间的关联。
共有2196名未接受过治疗的成年患者接受了为期1年的ART随访。采用比例风险回归来探讨基线特征与生存及失访（LTFU）之间的关联。
患者以女性为主（67%）。男性就诊时年龄较大且HIV病情更严重，在ART早期，男性的粗死亡率高于女性（22.8对12.5/100人年；P = 0.002）。然而，在多变量分析中，在调整了基线临床和免疫病毒学状态后，性别与生存无显著关联（风险比[HR]=1.46，95%置信区间[CI]=0.96 - 2.22；P = 0.076）。在ART后期（4 - 12个月），死亡率无性别差异（3.5对3.8/100人年；P = 0.817）。在多变量分析中，生存与年龄密切相关（HR = 1.05，95% CI = 1.02 - 1.09；P < 0.001），CD4细胞计数>150对<50个/微升（HR = 0.35，95% CI = 0.14 - 0.87；P = 0.023）以及有月收入对无月收入（HR = 0.47，95% CI = 0.25 - 0.88；P = 0.018）。有月收入可预防ART治疗1年时的失访（调整后HR = 0.56，95% CI = 0.39 - 0.82；P = 0.002）。
男性在ART治疗早期的高死亡率似乎主要是由于他们就诊时HIV病情更严重。需要努力让男性在HIV疾病早期就接受治疗，并减少ART项目结果中的社会经济不平等现象。
