Penot Pauline, Héma Arsène, Bado Guillaume, Kaboré Firmin, Soré Ibrahim, Sombié Diamasso, Traoré Jean-Richard, Guiard-Schmid Jean-Baptiste, Fontanet Arnaud, Slama Laurence, Bruno Sawadogo Adrien, Laurent Christian
Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso; UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier 1, Montpellier, France;
Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
J Int AIDS Soc. 2014 Jan 15;17(1):18646. doi: 10.7448/IAS.17.1.18646. eCollection 2014.
Gender differences in antiretroviral therapy (ART) outcomes are critical in sub-Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso.
We performed a case-control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV-1 or HIV-1+2, and on first-line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads <300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART.
Of 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viro-immunologic failure, and four (2.3%) had viro-clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p<0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor-based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77-3.60; p<0.001).
Men on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting.
在撒哈拉以南非洲地区，抗逆转录病毒疗法（ART）的治疗效果存在性别差异，这一现象至关重要。我们评估了在布基纳法索一家公共常规诊所（西非最大的诊所之一）接受治疗的成年患者中，性别与病毒学治疗失败之间的关联。
2012年7月至10月，我们在博博迪乌拉索日间护理中心接受抗逆转录病毒治疗的患者中开展了一项病例对照研究。患者年龄在15岁及以上、HIV-1或HIV-1+2检测呈阳性且接受一线抗逆转录病毒治疗至少六个月即为符合条件。病例为所有连续两次HIV病毒载量>1000拷贝/毫升（采用Biocentric Generic或雅培实时检测法），或一次HIV病毒载量>1000拷贝/毫升且伴有免疫或临床失败标准的患者。对照为所有HIV病毒载量<300拷贝/毫升的患者。使用多因素逻辑回归评估性别与病毒学治疗失败之间的关联，并根据年龄、教育程度、基线CD4+T细胞计数、初始和当前抗逆转录病毒治疗方案以及抗逆转录病毒治疗时间进行调整。
在2303名患者中（74.2%为女性；中位年龄：40岁；抗逆转录病毒治疗中位时间：34个月），172例出现病毒学治疗失败，2131例病毒学治疗成功。在前者中，130例（75.6%）确诊为病毒学治疗失败，38例（22.1%）为病毒免疫治疗失败，4例（2.3%）为病毒临床治疗失败。病例组中男性比例显著高于对照组（37.2%对24.9%；p<0.001）。与对照组相比，病例组患者年龄更小，开始抗逆转录病毒治疗时免疫缺陷更严重，接受基于蛋白酶抑制剂的抗逆转录病毒治疗方案的可能性更小，且接受抗逆转录病毒治疗的时间更长。调整后，男性性别仍与病毒学治疗失败密切相关（优势比2.52，95%置信区间：1.77-3.60；p<0.001）。
接受抗逆转录病毒治疗的男性似乎比女性更容易出现病毒学治疗失败。需要进一步研究来证实这种情况下男性预后较差，并确定其易感性的原因，以便优化艾滋病护理。从现在起，应努力支持非洲地区男性坚持接受抗逆转录病毒治疗。
