title: Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi.
abstract: 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.
authors.affiliation: Pingtung Christian Hospital, Pingtung, Taiwan, and Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Solomon Chih-Cheng
authors.initials: SC
authors.lastname: Chen
authors.forename: Joseph Kwong-Leung
authors.initials: JK
authors.lastname: Yu
authors.forename: Anthony David
authors.initials: AD
authors.lastname: Harries
authors.forename: Chin-Nam
authors.initials: CN
authors.lastname: Bong
authors.forename: Rose
authors.initials: R
authors.lastname: Kolola-Dzimadzi
authors.forename: Teck-Siang
authors.initials: TS
authors.lastname: Tok
authors.forename: Chwan-Chuen
authors.initials: CC
authors.lastname: King
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents