University Clinical Research Center, Faculty of Pharmacy and Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques, and Technologies of Bamako, Mali, West Africa.
Division of Infectious Diseases and Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Am J Trop Med Hyg. 2022 Jun 13;107(2):433-440. doi: 10.4269/ajtmh.21-1141. Print 2022 Aug 17.
Men and women often respond differently to infectious diseases and their treatments. Tuberculosis (TB) is a life-threatening communicable disease that affects more men than women globally. Whether male sex is an independent risk factor for unfavorable TB outcomes, however, has not been rigorously investigated in an African context, where individuals are likely exposed to different microbial and environmental factors. We analyzed data collected from a cohort study in Mali by focusing on newly diagnosed active pulmonary TB individuals who were treatment naive. We gathered baseline demographic, clinical, and microbiologic characteristics before treatment initiation and also at three time points during treatment. More males than females were affected with TB, as evidenced by a male-to-female ratio of 2.4:1. In addition, at baseline, males had a significantly higher bacterial count and shorter time to culture positivity as compared with females. Male sex was associated with lower smear negativity rate after 2 months of treatment also known as the intensive phase of treatment, but not at later time points. There was no relationship between patients' sex and mortality from any cause during treatment. This study suggests that sex-based differences in TB outcomes exist, with sex-specific effects on disease outcomes being more pronounced before treatment initiation and during the intensive phase of treatment rather than at later phases of treatment.
男性和女性对传染病及其治疗的反应往往不同。结核病（TB）是一种危及生命的传染性疾病，在全球范围内，男性患者多于女性。然而，在个体可能接触到不同微生物和环境因素的非洲背景下，男性性别是否是不利的结核病结局的独立危险因素，尚未得到严格的研究。我们通过关注新诊断为未经治疗的活动性肺结核个体，分析了马里一项队列研究中收集的数据。在开始治疗前和治疗期间的三个时间点收集了基线人口统计学、临床和微生物学特征。男性比女性更容易受到结核病的影响，男性与女性的比例为 2.4:1。此外，在基线时，与女性相比，男性的细菌计数明显更高，培养阳性的时间也更短。在治疗的第 2 个月（也称为治疗强化期）后，男性的痰涂片阴性率也较低，但在治疗的后期时间点则没有差异。在治疗期间，患者的性别与任何原因导致的死亡率之间没有关系。这项研究表明，结核病结局存在基于性别的差异，在治疗前和治疗强化期，疾病结局的性别特异性影响更为明显，而不是在治疗的后期阶段。
