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PLoS One. 2012;7(2):e31078. doi: 10.1371/journal.pone.0031078. Epub 2012 Feb 17.

Gender differences in immune reconstitution: a multicentric cohort analysis in sub-Saharan Africa.

Author information

1
Epicentre, Médecins Sans Frontières, Paris, France. david.maman@epicentre.msf.org

Abstract

BACKGROUND:

In sub-Saharan Africa, men living with HIV often start ART at more advanced stages of disease and have higher early mortality than women. We investigated gender difference in long-term immune reconstitution.

METHODS/PRINCIPAL FINDINGS:

Antiretroviral-naïve adults who received ART for at least 9 months in four HIV programs in sub-Saharan Africa were included. Multivariate mixed linear models were used to examine gender differences in immune reconstitution on first line ART. A total of 21,708 patients (68% women) contributed to 61,912 person-years of follow-up. At ART start,. Median CD4 at ART were 149 [IQR 85-206] for women and 125 cells/µL [IQR 63-187] for men. After the first year on ART, immune recovery was higher in women than in men, and gender-based differences increased by 20 CD4 cells/µL per year on average (95% CI 16-23; P<0.001). Up to 6 years after ART start, patients with low initial CD4 levels experienced similar gains compared to patients with high initial levels, including those with CD4>250 cells/µL (difference between patients with <50 cells/µL and those with >250 was 284 cells/µL; 95% CI 272-296; LR test for interaction with time p = 0.63). Among patients with initial CD4 count of 150-200 cells/µL, women reached 500 CD4 cells after 2.4 years on ART (95% CI 2.4-2.5) and men after 4.5 years (95% CI 4.1-4.8) of ART use.

CONCLUSION:

Women achieved better long-term immune response to ART, reaching CD4 level associated with lower risks of AIDS related morbidity and mortality quicker than men.

PMID:
22363550
PMCID:
PMC3281917
DOI:
10.1371/journal.pone.0031078
[Indexed for MEDLINE]
Free PMC Article
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