Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Womens Health (Larchmt). 2013 Feb;22(2):113-20. doi: 10.1089/jwh.2012.3585. Epub 2013 Jan 25.
Treatment outcomes for antiretroviral therapy (ART) patients may vary by gender, but estimates from current evidence may be confounded by disease stage and adherence. We investigated the gender differences in treatment response among HIV-positive patients virally suppressed within 6 months of treatment initiation.
We analyzed data from 7,354 patients initiating ART between April 2004 and April 2010 at Themba Lethu Clinic, a large urban public sector treatment facility in South Africa. We estimated the relations among gender, mortality, and mean CD4 response in HIV-infected adults virally suppressed within 6 months of treatment initiation and used inverse probability of treatment weights to correct estimates for loss to follow-up.
Male patients had a 20% greater risk of death at both 24 months and 36 months of follow-up compared to females. Older patients and those with a low hemoglobin level or low body mass index (BMI) were at increased risk of mortality throughout follow-up. Men gained fewer CD4 cells after treatment initiation than did women. The mean differences in CD4 count gains made by women and men between baseline and 12, 24, and 36 months were 28.2 cells/mm(3) (95% confidence interval [CI] 22.2-34.3), 60.8 cells/mm(3) (95% CI 71.1-50.5 cells/mm(3)), and 83.0 cells/mm(3) (95% CI 97.1-68.8 cells/mm(3)), respectively. Additionally, patients with a current detectable viral load (>400 copies/mL) and older patients had a lower mean CD4 increase at the same time points.
In this initially virally suppressed population, women showed consistently better immune response to treatment than did men. Promoting earlier uptake of HIV treatment among men may improve their immunologic outcomes.
抗逆转录病毒疗法 (ART) 患者的治疗结果可能因性别而异，但现有证据的估计可能因疾病阶段和依从性而受到混淆。我们调查了在开始治疗后 6 个月内病毒得到抑制的 HIV 阳性患者中治疗反应的性别差异。
我们分析了 2004 年 4 月至 2010 年 4 月期间在南非大型城市公立部门治疗机构 Themba Lethu 诊所开始接受 ART 的 7354 名患者的数据。我们估计了在开始治疗后 6 个月内病毒得到抑制的 HIV 感染成人中性别、死亡率和平均 CD4 反应之间的关系，并使用治疗反置概率权重来纠正因失访而导致的估计值。
与女性相比，男性在开始治疗后 24 个月和 36 个月时死亡的风险分别增加了 20%。在整个随访期间，年龄较大的患者以及血红蛋白水平或身体质量指数（BMI）较低的患者死亡风险增加。与女性相比，男性在开始治疗后获得的 CD4 细胞更少。在开始治疗后 12、24 和 36 个月时，女性和男性的 CD4 计数增益的平均差异分别为 28.2 个细胞/mm³（95%置信区间 [CI] 22.2-34.3）、60.8 个细胞/mm³（95% CI 71.1-50.5 个细胞/mm³）和 83.0 个细胞/mm³（95% CI 97.1-68.8 个细胞/mm³）。此外，当前可检测到病毒载量（>400 拷贝/mL）的患者和年龄较大的患者在相同时间点的 CD4 增加量较低。
在这个最初病毒得到抑制的人群中，女性对治疗的免疫反应始终优于男性。促进男性更早接受 HIV 治疗可能会改善他们的免疫结果。
