Title: Gender Differences in Survival among Adult Patients Starting Antiretroviral Therapy in South Africa: A Multicentre Cohort Study
Authors: Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann CJ, Lessells R, Maskew M, Prozesky H, Wood R, Johnson LF, Egger M, Boulle A, Myer L For IeDEA-SA.
Journal: PLoS Medicine,9(9):e1001304 (2012)
Increased mortality among men on antiretroviral therapy (ART) has been documented but remains poorly understood. We examined the magnitude of and risk factors for gender differences in mortality on ART.
Methods and Findings
Analyses included 46,201 ART-naive adults starting ART between January 2002 and December 2009 in eight ART programmes across South Africa (SA). Patients were followed from initiation of ART to outcome or analysis closure. The primary outcome was mortality; secondary outcomes were loss to follow-up (LTF), virologic suppression, and CD4+ cell count responses. Survival analyses were used to examine the hazard of death on ART by gender. Sensitivity analyses were limited to patients who were virologically suppressed and patients whose CD4+ cell count reached >200 cells/ul. We compared gender differences in mortality among HIV+ patients on ART with mortality in an age-standardised HIV-negative population.
Among 46,201 adults (65% female, median age 35 years), during 77,578 person-years of follow-up, men had lower median CD4+ cell counts than women (85 versus 110 cells/ul, p<0.001), were more likely to be classified WHO stage III/IV (86 versus 77%, p<0.001), and had higher mortality in crude (8.5 versus 5.7 deaths/100 person-years, p<0.001) and adjusted analyses (adjusted hazard ratio [AHR] 1.31, 95% CI 1.22?1.41). After 36 months on ART, men were more likely than women to be truly LTF (AHR 1.20, 95% CI 1.12?1.28) but not to die after LTF (AHR 1.04, 95% CI 0.86?1.25). Findings were consistent across all eight programmes. Virologic suppression was similar by gender; women had slightly better immunologic responses than men. Notably, the observed gender differences in mortality on ART were smaller than gender differences in age-standardised death rates in the HIV-negative South African population. Over time, non-HIV mortality appeared to account for an increasing proportion of observed mortality. The analysis was limited by missing data on baseline HIV disease characteristics, and we did not observe directly mortality in HIV-negative populations where the participating cohorts were located.
HIV-infected men have higher mortality on ART than women in South African programmes, but these differences are only partly explained by more advanced HIV disease at the time of ART initiation, differential LTF and subsequent mortality, and differences in responses to treatment. The observed differences in mortality on ART may be best explained by background differences in mortality between men and women in the South African population unrelated to the HIV/AIDS epidemic.
Citation: Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann CJ, Lessells R, Maskew M, Prozesky H, Wood R, Johnson LF, Egger M, Boulle A, Myer L For IeDEA-SA. Gender Differences in Survival among Adult Patients Starting Antiretroviral Therapy in South Africa: A Multicentre Cohort Study PLoS Medicine,9(9):e1001304 (2012).
'Tainted milk' from wet nurse HIV risk - Cape Argus - 2012-08-26
By BIANCA CAPAZORIO - A BABY girl who contracted HIV after being breast-fed by a well-meaning aunt has become the first proven case in SA to have contracted HIV from a surrogate feeder or 'wet nurse'.
Tainted Milk from Surrogate Feeder - SA DoH research brief - 2012-08-25
A baby girl who contracted HIV after being breast-fed by a well-meaning aunt has become the first proven case in South Africa to have contracted HIV from a surrogate feeder or 'wet nurse'. The case contained in new research highlights the importance of HIV testing of mothers and surrogate feeders at a time when the government is phasing out free infant formula in its clinics.
Local centre proves 'surrogate' HIV infection - Zululand Observer - 2012-08-24
The Africa Centre for Health and Population Studies, Zululand's HIV-AIDS research hub based near Mtubatuba, has revealed the first proven HIV surrogate transmission case in South Africa.
DNA sequencing confirms HIV transmission through surrogate breastfeeding - Wellcome Trust - 2012-08-23
DNA sequencing has provided evidence of HIV-1 transmission from an infected woman breastfeeding her niece in South Africa, drawing attention to infant feeding practices and the need for HIV testing of all breastfeeding surrogates as well as mothers.
Breastfeeding in the spotlight - SABC - 2012-08-16
A case where an aunt infected her niece with HIV through breastfeeding has drawn attention to feeding practices in South Africa. The case was published in the medical journal Lancet and highlighted the risk of HIV transmission from a surrogate carer, the Africa Centre for Health and Population Studies said today.
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