title: Gender differences in immune reconstitution: a multicentric cohort analysis in sub-Saharan Africa.
abstract: BACKGROUND
  In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution.
  
  
  RESULTS
  Antiretroviral-naïve adults who received ART for at least 9 months in four HIV programs in sub-Saharan Africa were included. Multivariate mixed linear models were used to examine gender differences in immune reconstitution on first line ART. A total of 21,708 patients (68% women) contributed to 61,912 person-years of follow-up. At ART start,. Median CD4 at ART were 149 [IQR 85-206] for women and 125 cells/µL [IQR 63-187] for men. After the first year on ART, immune recovery was higher in women than in men, and gender-based differences increased by 20 CD4 cells/µL per year on average (95% CI 16-23; P<0.001). Up to 6 years after ART start, patients with low initial CD4 levels experienced similar gains compared to patients with high initial levels, including those with CD4>250 cells/µL (difference between patients with <50 cells/µL and those with >250 was 284 cells/µL; 95% CI 272-296; LR test for interaction with time p = 0.63). Among patients with initial CD4 count of 150-200 cells/µL, women reached 500 CD4 cells after 2.4 years on ART (95% CI 2.4-2.5) and men after 4.5 years (95% CI 4.1-4.8) of ART use.
  
  
  CONCLUSIONS
  Women achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men.
authors.affiliation: Epicentre, Médecins Sans Frontières, Paris, France. david.maman@epicentre.msf.org
authors.forename: David
authors.initials: D
authors.lastname: Maman
authors.forename: Mar
authors.initials: M
authors.lastname: Pujades-Rodriguez
authors.forename: Fabien
authors.initials: F
authors.lastname: Subtil
authors.forename: Loretxu
authors.initials: L
authors.lastname: Pinoges
authors.forename: Megan
authors.initials: M
authors.lastname: McGuire
authors.forename: Rene
authors.initials: R
authors.lastname: Ecochard
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012727:Sex Characteristics; D013997:Time Factors