Mingaladon Specialist Hospital, Mingaladon Township, Yangon, Myanmar.
University of Medicine 2, North Okkalapa Township, Yangon, Myanmar.
AIDS Res Ther. 2021 Aug 9;18(1):50. doi: 10.1186/s12981-021-00364-w.
There is a growing recognition of the impact of gender and the social determinants of health on the clinical course of people living with HIV (PLHIV). However, the relative contribution of these factors to clinical outcomes of PLHIV is incompletely defined in many countries. This study was performed to gain a greater understanding of the non-clinical determinants of prognosis of PLHIV in Myanmar.
Selected demographic, behavioural and socioeconomic characteristics of outpatients at two specialist HIV hospitals and one general hospital in Yangon, Myanmar were correlated with their subsequent clinical course; a poor outcome was defined as death, hospitalisation, loss to follow-up or a detectable viral load at 6 months of follow-up.
221 consecutive individuals with advanced HIV commencing anti-retroviral therapy (ART) were enrolled in the study; their median CD4 T-cell count was 92 (44-158) cells/mm, 138 (62.4%) were male. Socioeconomic disadvantage was common: the median (interquartile range (IQR) monthly per-capita income in the cohort was US$48 (31-77); 153 (69.9%) had not completed high school. However, in a multivariate analysis that considered demographic, behavioural, clinical factors and social determinants of health, male gender was the only predictor of a poor outcome: odds ratio (95% confidence interval): 2.33 (1.26-4.32, p = 0.007). All eight of the deaths and hospitalisations in the cohort occurred in males (p = 0.03).
Men starting ART in Myanmar have a poorer prognosis than women. Expanded implementation of gender-specific management strategies is likely to be necessary to improve outcomes.
越来越多的人认识到性别和健康的社会决定因素对艾滋病毒感染者（PLHIV）的临床病程有影响。然而，在许多国家，这些因素对 PLHIV 临床结局的相对贡献仍不完全明确。本研究旨在更深入地了解缅甸 PLHIV 预后的非临床决定因素。
对仰光的两家专科 HIV 医院和一家综合医院的门诊患者的选定人口统计学、行为和社会经济特征与他们随后的临床病程进行了相关性分析；不良结局定义为死亡、住院、失访或 6 个月随访时病毒载量可检测。
本研究共纳入了 221 例开始接受抗逆转录病毒治疗（ART）的晚期 HIV 患者；他们的中位 CD4 T 细胞计数为 92（44-158）个/毫米，138 例（62.4%）为男性。社会经济劣势较为普遍：队列中每月人均收入中位数（四分位距（IQR）为 48 美元（31-77 美元）；153 例（69.9%）未完成高中学业。然而，在多变量分析中，考虑到人口统计学、行为、临床因素和健康的社会决定因素，男性性别是不良结局的唯一预测因素：比值比（95%置信区间）：2.33（1.26-4.32，p=0.007）。队列中所有 8 例死亡和住院均发生在男性（p=0.03）。
在缅甸开始接受 ART 的男性比女性预后更差。可能需要扩大实施针对特定性别的管理策略，以改善结局。
