title: Are there differences in disease progression and mortality among male and female HIV patients on antiretroviral therapy? A meta-analysis of observational cohorts.
abstract: Studies examining the sex differences in morbidity and mortality among HIV/AIDS patients have yielded inconsistent results. We conducted a meta-analysis of sex differences in disease progression and mortality among HIV/AIDS patients. Medical literature databases from inception to August 2014 were searched for published observational studies assessing sex differences in immunologic and virologic response, disease progression and mortality among HIV-infected patients. Random effects meta-analyses of 115 eligible studies were conducted to obtain pooled estimates of outcomes and heterogeneity was explored in sub-group analyses. Pooled estimates showed an increased risk of progression to AIDS (relative risk [RR]=1.11,95% CI=1.02-1.21) and all-cause mortality (RR=1.23, 95% CI=1.17-1.29) among males compared to females. All-cause mortality differed by sex only in low and middle income countries. The risk of AIDS-related mortality (RR=1.03, 95% CI=0.82-1.30), immunologic failure (RR=1.19,95% CI: 0.97-1.47), virologic suppression (RR=0.98, 95% CI=0.84-1.14), virologic failure (RR=1.26, 95% CI=0.99-1.61) and the change in CD4 cell count (Weighted mean difference [WMD] = -5.15, 95% CI= -13.57 to 3.28) did not differ by sex. These findings were modified by disease severity, adherence and use of highly active antiretroviral therapy. We conclude that HIV-related disease progression and survival outcomes are poorer in males.
authors.affiliation: a Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston MA , USA.
authors.forename: A I
authors.initials: AI
authors.lastname: Abioye
authors.affiliation: b Department of Epidemiology , Brown University , Providence , RI , USA.
authors.forename: A I
authors.initials: AI
authors.lastname: Soipe
authors.affiliation: c Department of Health Management and Policy , University of Iowa , Iowa City , IA , USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Salako
authors.affiliation: d School of Life & Health Sciences, Aston University , Birmingham , UK.
authors.forename: M O
authors.initials: MO
authors.lastname: Odesanya
authors.affiliation: e Department of Family Medicine , General Hospital , Odan , Lagos , Nigeria.
authors.forename: T A
authors.initials: TA
authors.lastname: Okuneye
authors.affiliation: f Sanitas Hospital , Dar es Salaam , Tanzania.
authors.forename: A I
authors.initials: AI
authors.lastname: Abioye
authors.affiliation: g Department of Hematology , Lagos State University Teaching Hospital , Ikeja , Lagos , Nigeria.
authors.forename: K A
authors.initials: KA
authors.lastname: Ismail
authors.affiliation: h Division of Nutritional Sciences , Cornell University , Ithaca , NY , USA.
authors.forename: M O
authors.initials: MO
authors.lastname: Omotayo
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D023801:Directly Observed Therapy; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality* / Q000821:virology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D009017:Morbidity; D012737:Sex Factors; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D044966:Anti-Retroviral Agents
keywords: CD4 cell count; HIV/AIDS; antiretroviral therapy; gender; mortality; viral load