Epicentre, Médecins Sans Frontières, Paris, France.
PLoS One. 2012;7(2):e31078. doi: 10.1371/journal.pone.0031078. Epub 2012 Feb 17.
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; 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>250 cells/µL (difference between patients with <50 cells/µL and those 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.
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.
在撒哈拉以南非洲，与女性相比，感染艾滋病毒的男性往往在疾病的晚期才开始接受抗逆转录病毒治疗，且早期死亡率更高。本研究旨在调查长期免疫重建方面的性别差异。
方法/主要发现：本研究纳入了在撒哈拉以南非洲的四个艾滋病毒项目中接受至少 9 个月抗逆转录病毒治疗的抗逆转录病毒初治成年人。采用多变量混合线性模型来检测一线抗逆转录病毒治疗中免疫重建的性别差异。共有 21708 名患者（68%为女性）纳入了 61912 人年的随访研究。在开始抗逆转录病毒治疗时，女性的 CD4 中位数为 149[85-206]个细胞/µL，男性为 125 个细胞/µL[63-187]。在开始抗逆转录病毒治疗后的第一年，女性的免疫恢复高于男性，且性别差异平均每年增加 20 个细胞/µL（95%CI 16-23；P<0.001）。在开始抗逆转录病毒治疗后长达 6 年的时间里，与初始 CD4 水平较高的患者相比，初始 CD4 水平较低的患者也获得了相似的获益，包括 CD4 水平大于 250 个细胞/µL 的患者（初始 CD4 水平<50 个细胞/µL 与>250 个细胞/µL 患者之间的差异为 284 个细胞/µL；95%CI 272-296；时间与交互作用的似然比检验 P=0.63）。在初始 CD4 计数为 150-200 个细胞/µL 的患者中，女性在开始抗逆转录病毒治疗 2.4 年后（95%CI 2.4-2.5）达到 500 个细胞/µL，而男性则需要 4.5 年（95%CI 4.1-4.8）。
与男性相比，女性对抗逆转录病毒治疗的长期免疫反应更好，更早地达到与降低艾滋病相关发病率和死亡率相关的 CD4 水平。
