Chen Meiling, Dou Zhihui, Wang Liming, Wu Yasong, Zhao Decai, Gan Xiumin, Hu Ran, Ma Ye, Zhang Fujie
*Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; †Beijing Ditan Hospital, Capital Medical University, Beijing, China; ‡Clinical Center for HIV/AIDS, Capital Medical University, Beijing, China; and §Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
J Acquir Immune Defic Syndr. 2017 Nov 1;76(3):281-288. doi: 10.1097/QAI.0000000000001500.
Women now account for about half of all people living with HIV worldwide, but researchers lack clear information and large population-based study about gender differences in treatment outcomes.
A nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program was performed. Antiretroviral-naive patients older than 18 years initiating standard antiretroviral therapy between January 1, 2010, and December 31, 2011, were included and followed up to December 31, 2015. We used modified Poisson regression models to estimate the impact of gender on virological suppression and retention in treatment, and Kaplan-Meier analysis and Cox proportional hazard models to evaluate gender difference in mortality.
Sixty-eight thousand six hundred forty-six patients [46,083 (67.1%) men and 22,563 (32.9%) women] with HIV met eligibility criteria. Women were significantly more likely to achieve virological suppression than men both at 12 months [adjusted relative risk (aRR) 1.02, 95% confidence interval (CI): 1.01 to 1.03, P < 0.001] and 48 months (aRR 1.01, 95% CI: 1.00 to 1.02, P = 0.005) after initiating antiretroviral treatment. Women were also more likely to remain in treatment at 12 months (aRR 1.02, 95% CI: 1.01 to 1.02, P < 0.001) and 48 months (aRR 1.04, 95% CI: 1.03 to 1.05, P < 0.001), although the difference became insignificant in alive patients. All-cause mortality was lower in women than in men (2.34 vs. 4.03 deaths/100PY, adjusted hazard ratio 0.72, 95% CI: 0.67 to 0.77, P < 0.001).
In China, women are more likely to achieve virological suppression, remain in treatment, and have a significantly lower risk of death than men. Future studies could take both biological and sociobehavioral factors into analysis to clarify the influence factors.
目前，全球感染艾滋病毒的人群中女性约占一半，但研究人员缺乏关于治疗结果性别差异的明确信息以及基于大规模人群的研究。
利用中国国家免费抗逆转录病毒治疗项目的数据进行了一项全国性回顾性观察队列研究。纳入2010年1月1日至2011年12月31日期间开始接受标准抗逆转录病毒治疗的18岁以上未接受过抗逆转录病毒治疗的患者，并随访至2015年12月31日。我们使用改良泊松回归模型来估计性别对病毒学抑制和治疗留存率的影响，并使用Kaplan-Meier分析和Cox比例风险模型来评估死亡率的性别差异。
68646例艾滋病毒感染者符合纳入标准[男性46083例（67.1%），女性22563例（32.9%）]。开始抗逆转录病毒治疗后12个月[调整相对风险（aRR）1.02，95%置信区间（CI）：1.01至1.03，P<0.001]和48个月时（aRR 1.01，95%CI：1.00至1.02，P = 0.005），女性实现病毒学抑制的可能性显著高于男性。女性在12个月（aRR 1.02，95%CI：1.01至1.02，P<0.001）和48个月时（aRR 1.04，95%CI：1.03至1.05，P<0.001）继续接受治疗的可能性也更高，尽管在存活患者中这种差异变得不显著。女性的全因死亡率低于男性（2.34 vs. 4.03例死亡/100人年，调整风险比0.72，95%CI：0.67至0.77，P<0.001）。
在中国，女性比男性更有可能实现病毒学抑制、继续接受治疗，且死亡风险显著更低。未来的研究可以综合考虑生物学和社会行为因素进行分析，以明确影响因素。
