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Aumento en la mortalidad de hombres adultos con SIDA relacionada con el incumplimiento de la terapia antirretroviral en Malawi
Author(s) -
Chen Solomon ChihCheng,
Yu Joseph KwongLeung,
Harries Anthony David,
Bong ChinNam,
KololaDzimadzi Rose,
Tok TeckSiang,
King ChwanChuen,
Wang JungDer
Publication year - 2008
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2008.02029.x
Subject(s) - medicine , hazard ratio , antiretroviral therapy , confidence interval , retrospective cohort study , proportional hazards model , human immunodeficiency virus (hiv) , demography , pediatrics , surgery , viral load , family medicine , sociology
Summary Objective To investigate the effect of gender on mortality of HIV‐infected adults receiving antiretroviral therapy (ART) and its possible reasons. Methods A retrospective study to review the records for outcomes of adult cases receiving ART at Mzuzu Central Hospital, Malawi, between July 2004 and December 2006. Results Over the study period, 2838 adult AIDS patients received ART. Of these, 2029 (71.5%) were alive and still on ART, 376 (13.2%) were dead and 433 (15.3%) were lost to follow‐up. Survival analysis with Kaplan–Meier estimator showed significantly higher survival rates among females than males in WHO stage 1, 2 and 3 (both P < 0.0001) and borderline in stage 4 ( P = 0.076). The Cox model revealed a death hazard ratio (males vs . females) of 1.70 (95% confidence interval 1.35–2.15) after controlling for WHO clinical stages, body mass index and age. More men than women were lost to follow‐up in all occupations except health workers. Conclusions The most important reasons for a higher mortality in male patients starting ART may relate to their seeking medical care at a more advanced stage of immunodeficiency and poorer compliance with therapy. The issue needs to be addressed in scaling up ART programmes in Africa.