title: The vulnerability of men to virologic failure during antiretroviral therapy in a public routine clinic in Burkina Faso.
abstract: BACKGROUND
  Gender differences in antiretroviral therapy (ART) outcomes are critical in sub-Saharan Africa. We assessed the association between gender and virologic failure among adult patients treated in a public routine clinic (one of the largest in West Africa) in Burkina Faso.
  
  
  METHODS
  We performed a case-control study between July and October 2012 among patients who had received ART at the Bobo Dioulasso Day Care Unit. Patients were eligible if they were 15 years or older, positive for HIV-1 or HIV-1+2, and on first-line ART for at least six months. Cases were all patients with two consecutive HIV loads >1000 copies/mL (Biocentric Generic or Abbott Real Time assays), or one HIV load >1000 copies/mL associated with immunologic or clinical failure criteria. Controls were all patients who only had HIV loads <300 copies/mL. The association between gender and virologic failure was assessed using a multivariate logistic regression, adjusted on age, level of education, baseline CD4+ T cell count, first and current antiretroviral regimens and time on ART.
  
  
  RESULTS
  Of 2303 patients (74.2% women; median age: 40 years; median time on ART: 34 months), 172 had virologic failure and 2131 had virologic success. Among the former, 130 (75.6%) had confirmed virologic failure, 38 (22.1%) had viro-immunologic failure, and four (2.3%) had viro-clinical failure. The proportion of men was significantly higher among the cases than among the controls (37.2% vs. 24.9%; p<0.001). Compared to controls, cases were also younger, more immunodeficient at ART initiation, less likely to receive a protease inhibitor-based antiretroviral regimen and had spent a longer period of time on ART. After adjustment, male gender remained strongly associated with virologic failure (odds ratio 2.52, 95% CI: 1.77-3.60; p<0.001).
  
  
  CONCLUSIONS
  Men on ART appeared more vulnerable to virologic failure than women. Additional studies are needed to confirm the poorer prognosis of men in this setting and to determine the causes for their vulnerability in order to optimize HIV care. From now on, efforts should be made to support the adherence of men to ART in the African setting.
authors.affiliation: Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso; UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier 1, Montpellier, France; penotpauline@gmail.com.
authors.forename: Pauline
authors.initials: P
authors.lastname: Penot
authors.affiliation: Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
authors.forename: Arsène
authors.initials: A
authors.lastname: Héma
authors.affiliation: Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Bado
authors.affiliation: Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
authors.forename: Firmin
authors.initials: F
authors.lastname: Kaboré
authors.affiliation: Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Soré
authors.affiliation: Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
authors.forename: Diamasso
authors.initials: D
authors.lastname: Sombié
authors.affiliation: Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
authors.forename: Jean-Richard
authors.initials: JR
authors.lastname: Traoré
authors.affiliation: Initiatives Conseil International - Santé, Ouagadougou, Burkina Faso.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Guiard-Schmid
authors.affiliation: Emerging Diseases Epidemiology Unit, Institut Pasteur, Paris, France; Conservatoire National des Arts et Métiers, Paris, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Fontanet
authors.affiliation: Service des maladies infectieuses et tropicales, hôpital Tenon, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Slama
authors.affiliation: Hôpital de jour du service de médecine interne du CHU Sanou Souro, Bobo-Dioulasso, Burkina Faso.
authors.forename: Adrien
authors.initials: A
authors.lastname: Bruno Sawadogo
authors.affiliation: UMI 233, Institut de Recherche pour le Développement (IRD), Université Montpellier 1, Montpellier, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Laurent
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002050:Burkina Faso / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D015498:HIV-2 / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D017211:Treatment Failure; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; HIV; antiretroviral; efficacy; gender; virologic failure