title: Differential effects of sex in a West African cohort of HIV-1, HIV-2 and HIV-1/2 dually infected patients: men are worse off.
abstract: OBJECTIVE
  Several studies have reported conflicting effects of sex on HIV-1 infection. We describe differences in baseline characteristics and assess the impact of sex on HIV progression among patients at a clinic with many HIV-2 and HIV-1/2 dually infected patients.
  
  
  METHODS
  This study utilised a retrospective cohort of treatment-naïve adults at the largest HIV clinic in Guinea-Bissau from 6 June 2005 to 1 December 2013. Baseline characteristics were assessed and the patients followed until death, transfer, loss to follow-up, or 1 June 2014. We estimated the time from the first clinic visit until initiation of ART, death or loss to follow-up using Cox proportional hazard models.
  
  
  RESULTS
  A total of 5694 patients were included in the study, 3702 women (65%) and 1992 men (35%). Women were more likely than men to be infected with HIV-2 (19% vs. 15%, P < 0.01) or dually infected with HIV-1/2 (11% vs. 9%, P = 0.02). For all HIV types, women were younger (median 35 vs. 40 years), less likely to have schooling (55% vs. 77%) or to be married (46% vs. 67%), and had higher baseline CD4 cell counts (median 214 vs. 178 cells/μl). Men had a higher age-adjusted mortality rate (hazard rate ratio (HRR) 1.29, 95% confidence interval (CI) 1.09-1.52) and were more often lost to follow-up (HRR 1.27, 95% CI 1.17-1.39).
  
  
  CONCLUSIONS
  Significant differences exist between HIV-infected men and women regardless of HIV type. Men seek treatment at a later stage and, despite better socio-economic status, have higher mortality and loss to follow-up than women.
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Sanne
authors.initials: S
authors.lastname: Jespersen
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.|Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Bo Langhoff
authors.initials: BL
authors.lastname: Hønge
authors.affiliation: Department of Experimental Medical Science, Section of Molecular Virology, Lund University, Lund, Sweden.|Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
authors.forename: Joakim
authors.initials: J
authors.lastname: Esbjörnsson
authors.affiliation: National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau.
authors.forename: Candida
authors.initials: C
authors.lastname: Medina
authors.affiliation: National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau.
authors.forename: David
authors.initials: D
authors.lastname: da Silva Té
authors.affiliation: National HIV Programme, Ministry of Health, Bissau, Guinea-Bissau.
authors.forename: Faustino Gomes
authors.initials: FG
authors.lastname: Correira
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Alex Lund
authors.initials: AL
authors.lastname: Laursen
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Østergaard
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.
authors.forename: Andreas
authors.initials: A
authors.lastname: Andersen
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Research Center for Vitamins and Vaccines (CVIVA), Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Aaby
authors.affiliation: Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Erikstrup
authors.affiliation: Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau.|Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.|GloHAU, Center for Global Health, School of Public Health, Aarhus University, Aarhus, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Wejse
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D015497:HIV-1; D015498:HIV-2; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D008571:Men; D054526:Men's Health; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; Afrique; Guinea-Bissau; Guinée-Bissau; HIV; HIV-2; Sex; Sexo; VIH; VIH-2; sexe; África