Boullé Charlotte, Kouanfack Charles, Laborde-Balen Gabrièle, Boyer Sylvie, Aghokeng Avelin F, Carrieri Maria P, Kazé Serge, Dontsop Marlise, Mben Jean-Marc, Koulla-Shiro Sinata, Peytavin Gilles, Spire Bruno, Delaporte Eric, Laurent Christian
*Institut de Recherche pour le Développement, University Montpellier 1, UMI 233 TransVIHMI, Montpellier, France; †Central Hospital, Yaoundé, Cameroon; ‡INSERM, U912 (SESSTIM), Marseille, France; §University Aix Marseille, IRD, UMR-S912, Marseille, France; ‖ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; ¶AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie, Paris, France; #IAME, UMR 1137, University Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France; and **Department of Infectious and Tropical Diseases, University Hospital, Montpellier, France.
J Acquir Immune Defic Syndr. 2015 Jul 1;69(3):355-64. doi: 10.1097/QAI.0000000000000604.
Evidence of gender differences in antiretroviral treatment (ART) outcomes in sub-Saharan Africa is conflicting. Our objective was to assess gender differences in (1) adherence to ART and (2) virologic failure, immune reconstitution, mortality, and disease progression adjusting for adherence.
Cohort study among 459 ART-naive patients followed up 24 months after initiation in 2006-2010 in 9 rural district hospitals. Adherence to ART was assessed using (1) a validated tool based on multiple patient self-reports and (2) antiretroviral plasma concentrations. The associations between gender and the outcomes were assessed using multivariate mixed models or accelerated time failure models.
One hundred thirty-five patients (29.4%) were men. At baseline, men were older, had higher body mass index and hemoglobin level, and received more frequently efavirenz than women. Gender was not associated with self-reported adherence (P = 0.872, 0.169, and 0.867 for moderate adherence, low adherence, and treatment interruption, respectively) or with antiretroviral plasma concentrations (P = 0.549 for nevirapine/efavirenz). In contrast, male gender was associated with virologic failure [odds ratio: 2.18, 95% confidence interval (CI): 1.31 to 3.62, P = 0.003], lower immunologic reconstitution (coefficient: -58.7 at month 24, 95% CI: -100.8 to -16.6, P = 0.006), and faster progression to death (time ratio: 0.30, 95% CI: 0.12 to 0.78, P = 0.014) and/or to World Health Organization stage 4 event (time ratio: 0.27, 95% CI: 0.09 to 0.79, P = 0.017).
Our study provides important evidence that African men are more vulnerable to ART failure than women and that the male vulnerability extends beyond adherence issues. Additional studies are needed to determine the causes for this vulnerability to optimize HIV care. However, personalized adherence support remains crucial.
撒哈拉以南非洲地区抗逆转录病毒治疗（ART）结果存在性别差异的证据相互矛盾。我们的目标是评估在（1）ART依从性和（2）病毒学失败、免疫重建、死亡率及疾病进展（对依从性进行调整后）方面的性别差异。
对2006年至2010年在9家农村地区医院开始治疗的459例未接受过ART治疗的患者进行队列研究，随访24个月。使用（1）基于多份患者自我报告的有效工具和（2）抗逆转录病毒血浆浓度来评估ART依从性。使用多变量混合模型或加速时间失败模型评估性别与结局之间的关联。
135例患者（29.4%）为男性。在基线时，男性年龄更大，体重指数和血红蛋白水平更高，且比女性更频繁地接受依非韦伦治疗。性别与自我报告的依从性（中度依从性、低依从性和治疗中断的P值分别为0.872、0.169和0.867）或抗逆转录病毒血浆浓度（奈韦拉平/依非韦伦的P值为0.549）无关。相比之下，男性与病毒学失败相关[比值比：2.18，95%置信区间（CI）：1.31至3.62，P = （此处原文为0.003，但按格式应为0.003）]、免疫重建较低（第24个月时系数为-58.7，95%CI：-100.8至-16.6，P = 0.006）以及死亡进展更快（时间比：0.30, 95%CI：0.12至0.78，P = 0.014）和/或世界卫生组织4期事件进展更快（时间比：0.27, 95%CI：0.09至0.79，P = 0.017）。
我们的研究提供了重要证据，表明非洲男性比女性更容易出现ART失败，且男性的易感性不仅限于依从性问题。需要进一步研究以确定这种易感性的原因，从而优化HIV护理。然而，个性化的依从性支持仍然至关重要。
