title: Gender differences in HIV disease progression and treatment outcomes among HIV patients one year after starting antiretroviral treatment (ART) in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  We investigated gender differences in treatment outcome during first line antiretroviral treatment (ART) in a hospital setting in Tanzania, assessing clinical, social demographic, virological and immunological factors.
  
  
  METHODS
  We conducted a cohort study involving HIV infected patients scheduled to start ART and followed up to 1 year on ART. Structured questionnaires and patients file review were used to collect information and blood was collected for CD4 and viral load testing. Gender differences were assessed using Kruskal-Wallis test and chi-square test for continuous and categorical data respectively. Survival distributions for male and female patients were estimated using the Kaplan-Meier method and compared using Cox proportional hazards models.
  
  
  RESULTS
  Of 234 patients recruited in this study, 70% were females. At baseline, women had significantly lower education level; lower monthly income, lower knowledge on ARV, less advanced HIV disease (33% women; 47% men started ART at WHO stage IV, p = 0.04), higher CD4 cell count (median 149 for women, 102 for men, p = 0.02) and higher BMI (p = 0.002). After 1 year of standard ART, a higher proportion of females survived although this was not significant, a significantly higher proportion of females had undetectable plasma viral load (69% women, 45% men, p = 0.003), however females ended at a comparable CD4 cell count (median CD4, 312 women; 321 men) signifying a worse CD4 cell increase (p = 0.05), even though they still had a higher BMI (p = 0.02). The unadjusted relative hazard for death for men compared to women was 1.94. After correcting for confounding factors, the Cox proportional hazards showed no significant difference in the survival rate (relative hazard 1.02).
  
  
  CONCLUSIONS
  We observed women were starting treatment at a less advanced disease stage, but they had a lower socioeconomical status. After one year, both men and women had similar clinical and immunological conditions. It is not clear why women lose their immunological advantage over men despite a better virological treatment response. We recommend continuous follow up of this and more cohorts of patients to better understand the underlying causes for these differences and whether this will translate also in longer term differences.
authors: Ministry of Health and Social Welfare, Box 65545, Dar es Salaam, Tanzania. fausta_mosha@yahoo.com
authors: Fausta
authors: F
authors: Mosha
authors: Victor
authors: V
authors: Muchunguzi
authors: Mecey
authors: M
authors: Matee
authors: Raphael Z
authors: RZ
authors: Sangeda
authors: Jurgen
authors: J
authors: Vercauteren
authors: Peter
authors: P
authors: Nsubuga
authors: Eligius
authors: E
authors: Lyamuya
authors: Anne-Mieke
authors: AM
authors: Vandamme
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology* / Q000821:virology; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013636:Tanzania; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load / Q000706:statistics & numerical data
chemical_list: D019380:Anti-HIV Agents