title: Outcomes in the first year after initiation of first-line HAART among heterosexual men and women in the UK CHIC Study.
abstract: BACKGROUND
  We analysed the influence of gender on use and outcomes of first-line HAART in a UK cohort.
  
  
  METHODS
  Analyses included heterosexuals starting HAART from 1998-2007 with pre-treatment CD4(+) T-cell count<350 cells/mm(3) and viral load (VL)>500 copies/ml. Virological suppression (<50 copies/ml), virological rebound (>500 copies/ml), CD4(+) T-cell counts at 6 and 12 months, clinical events and treatment discontinuation/switch in the first year of HAART were compared using linear, logistic and Cox regression.
  
  
  RESULTS
  Compared with women (n=2,179), men (n=1,487) were older and had lower CD4(+) T-cell count and higher VL at start of HAART. Median follow-up was 3.8 years (IQR 2.0-6.2). At 6 and 12 months, 72.7% and 75.3% had VL≤50 copies/ml, with no large differences between genders at either time after adjustment for confounders (6 months, OR 0.92 [95% CI 0.76-1.13]; 12 months, OR 1.06 [95% CI 0.85-1.31]). Overall, 79.4% patients achieved virological suppression and 19.2% experienced virological rebound, without gender differences, although men had an increased risk of rebound after excluding pregnant women (adjusted relative hazard [RH] 1.33 [95% CI 1.04-1.71]). Mean CD4(+) T-cell count increases at 6 and 12 months were, respectively, 112 and 156 cells/mm(3) overall, with mean differences between men and women of -14.6 cells/mm(3) (95% CI -24.6--4.5) and -12.1 cells/mm(3) (95% CI -24.4-0.2) at 6 and 12 months, respectively. Clinical progression was similar in men and women, but men were less likely to experience treatment discontinuation/switch (adjusted RH 0.72 [95% CI 0.63-0.83]).
  
  
  CONCLUSIONS
  Despite higher discontinuation rates among women, men had an increased risk of virological rebound and slightly poorer CD4(+) T-cell count responses. Identifying the reasons underlying treatment discontinuation/switch may help optimize treatment strategies for both genders.
authors: St Stephen's AIDS Trust Clinical Trials Unit, Chelsea and Westminster NHS Foundation Trust, London, UK. t.barber@nhs.net
authors: Tristan J
authors: TJ
authors: Barber
authors: Anna Maria
authors: AM
authors: Geretti
authors: Jane
authors: J
authors: Anderson
authors: Achim
authors: A
authors: Schwenk
authors: Andrew N
authors: AN
authors: Phillips
authors: Loveleen
authors: L
authors: Bansi
authors: Richard
authors: R
authors: Gilson
authors: Teresa
authors: T
authors: Hill
authors: John
authors: J
authors: Walsh
authors: Martin
authors: M
authors: Fisher
authors: Margaret
authors: M
authors: Johnson
authors: Frank
authors: F
authors: Post
authors: Philippa
authors: P
authors: Easterbrook
authors: Brian
authors: B
authors: Gazzard
authors: Adrian
authors: A
authors: Palfreeman
authors: Chloe
authors: C
authors: Orkin
authors: Clifford
authors: C
authors: Leen
authors: Mark
authors: M
authors: Gompels
authors: David
authors: D
authors: Dunn
authors: Valerie
authors: V
authors: Delpech
authors: Deenan
authors: D
authors: Pillay
authors: Caroline A
authors: CA
authors: Sabin
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D020010:Heterosexuality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000208:ethnology; D019562:Viral Load