Open AccessMale gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda
Author(s) -
Mills Edward J,
Bakanda Celestin,
Birungi Josephine,
Chan Keith,
Hogg Robert S,
Ford Nathan,
Nachega Jean B,
Cooper Curtis L
Publication year - 2011
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1186/1758-2652-14-52
Subject(s) - medicine , demography , hazard ratio , proportional hazards model , cohort , mortality rate , antiretroviral therapy , cohort study , survival analysis , human immunodeficiency virus (hiv) , confidence interval , viral load , immunology , sociology
Background Because men in Africa are less likely to access HIV/AIDS care than women, we aimed to determine if men have differing outcomes from women across a nationally representative sample of adult patients receiving combination antiretroviral therapy in Uganda. Methods We estimated survival distributions for adult male and female patients using Kaplan‐Meier, and constructed multivariable regressions to model associations of baseline variables with mortality. We assessed person‐years of life lost up to age 55 by sex. To minimize the impact of patient attrition, we assumed a weighted 30% mortality rate among those lost to follow up. Results We included data from 22,315 adults receiving antiretroviral therapy. At baseline, men tended to be older, had lower CD4 baseline values, more advanced disease, had pulmonary tuberculosis and had received less treatment follow up (all at p < 0.001). Loss to follow up differed between men and women (7.5 versus 5.9%, p < 0.001). Over the period of study, men had a significantly increased risk of death compared with female patients (adjusted hazard ratio 1.43, 95% CI 1.31‐1.57, p < 0.001). The crude mortality rate for males differed importantly from females (43.9, 95% CI 40.7‐47.0/1000 person‐years versus 26.9, 95% CI 25.4‐28.5/1000 person years, p < 0.001). The probability of survival was 91.2% among males and 94.1% among females at 12 months. Person‐years of life lost was lower for females than males (689.7 versus 995.9 per 1000 person‐years, respectively). Conclusions In order to maximize the benefits of antiretroviral therapy, treatment programmes need to be gender sensitive to the specific needs of both women and men. Particular efforts are needed to enroll men earlier into care.