title: Gender Differences in Adherence and Response to Antiretroviral Treatment in the Stratall Trial in Rural District Hospitals in Cameroon.
abstract: Evidence of gender differences in antiretroviral treatment (ART) outcomes in sub-Saharan Africa is conflicting. Our objective was to assess gender differences in (1) adherence to ART and (2) virologic failure, immune reconstitution, mortality, and disease progression adjusting for adherence.
  
  
  
  Cohort study among 459 ART-naive patients followed up 24 months after initiation in 2006-2010 in 9 rural district hospitals. Adherence to ART was assessed using (1) a validated tool based on multiple patient self-reports and (2) antiretroviral plasma concentrations. The associations between gender and the outcomes were assessed using multivariate mixed models or accelerated time failure models.
  
  
  
  One hundred thirty-five patients (29.4%) were men. At baseline, men were older, had higher body mass index and hemoglobin level, and received more frequently efavirenz than women. Gender was not associated with self-reported adherence (P = 0.872, 0.169, and 0.867 for moderate adherence, low adherence, and treatment interruption, respectively) or with antiretroviral plasma concentrations (P = 0.549 for nevirapine/efavirenz). In contrast, male gender was associated with virologic failure [odds ratio: 2.18, 95% confidence interval (CI): 1.31 to 3.62, P = 0.003], lower immunologic reconstitution (coefficient: -58.7 at month 24, 95% CI: -100.8 to -16.6, P = 0.006), and faster progression to death (time ratio: 0.30, 95% CI: 0.12 to 0.78, P = 0.014) and/or to World Health Organization stage 4 event (time ratio: 0.27, 95% CI: 0.09 to 0.79, P = 0.017).
  
  
  
  Our study provides important evidence that African men are more vulnerable to ART failure than women and that the male vulnerability extends beyond adherence issues. Additional studies are needed to determine the causes for this vulnerability to optimize HIV care. However, personalized adherence support remains crucial.
authors.affiliation: *Institut de Recherche pour le Développement, University Montpellier 1, UMI 233 TransVIHMI, Montpellier, France; †Central Hospital, Yaoundé, Cameroon; ‡INSERM, U912 (SESSTIM), Marseille, France; §University Aix Marseille, IRD, UMR-S912, Marseille, France; ‖ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; ¶AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie, Paris, France; #IAME, UMR 1137, University Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France; and **Department of Infectious and Tropical Diseases, University Hospital, Montpellier, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Boullé
authors.forename: Charles
authors.initials: C
authors.lastname: Kouanfack
authors.forename: Gabrièle
authors.initials: G
authors.lastname: Laborde-Balen
authors.forename: Sylvie
authors.initials: S
authors.lastname: Boyer
authors.forename: Avelin F
authors.initials: AF
authors.lastname: Aghokeng
authors.forename: Maria P
authors.initials: MP
authors.lastname: Carrieri
authors.forename: Serge
authors.initials: S
authors.lastname: Kazé
authors.forename: Marlise
authors.initials: M
authors.lastname: Dontsop
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Mben
authors.forename: Sinata
authors.initials: S
authors.lastname: Koulla-Shiro
authors.forename: Gilles
authors.initials: G
authors.lastname: Peytavin
authors.forename: Bruno
authors.initials: B
authors.lastname: Spire
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.forename: Christian
authors.initials: C
authors.lastname: Laurent
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use*; D002163:Cameroon / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D012424:Rural Population; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents