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Differential effects of sex in a West African cohort of HIV‐1, HIV‐2 and HIV‐1/2 dually infected patients: men are worse off
Author(s) -
Jespersen Sanne,
Hønge Bo Langhoff,
Esbjörnsson Joakim,
Medina Candida,
Silva Té David,
Correira Faustino Gomes,
Laursen Alex Lund,
Østergaard Lars,
Andersen Andreas,
Aaby Peter,
Erikstrup Christian,
Wejse Christian
Publication year - 2016
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/tmi.12646
Subject(s) - medicine , hazard ratio , confidence interval , cohort , human immunodeficiency virus (hiv) , proportional hazards model , cohort study , population , demography , immunology , sociology , environmental health
Objectives Several studies have reported conflicting effects of sex on HIV ‐1 infection. We describe differences in baseline characteristics and assess the impact of sex on HIV progression among patients at a clinic with many HIV‐2 and HIV‐1/2 dually infected patients. Methods This study utilised a retrospective cohort of treatment‐naïve adults at the largest HIV clinic in Guinea‐Bissau from 6 June 2005 to 1 December 2013. Baseline characteristics were assessed and the patients followed until death, transfer, loss to follow‐up, or 1 June 2014. We estimated the time from the first clinic visit until initiation of ART , death or loss to follow‐up using Cox proportional hazard models. Results A total of 5694 patients were included in the study, 3702 women (65%) and 1992 men (35%). Women were more likely than men to be infected with HIV ‐2 (19% vs . 15%, P < 0.01) or dually infected with HIV ‐1/2 (11% vs . 9%, P = 0.02). For all HIV types, women were younger (median 35 vs . 40 years), less likely to have schooling (55% vs . 77%) or to be married (46% vs . 67%), and had higher baseline CD 4 cell counts (median 214 vs . 178 cells/ μ l). Men had a higher age‐adjusted mortality rate (hazard rate ratio ( HRR ) 1.29, 95% confidence interval ( CI ) 1.09–1.52) and were more often lost to follow‐up ( HRR 1.27, 95% CI 1.17–1.39). Conclusion Significant differences exist between HIV ‐infected men and women regardless of HIV type. Men seek treatment at a later stage and, despite better socio‐economic status, have higher mortality and loss to follow‐up than women.