Publications des scientifiques de l'IRD

Boullé Charlotte, Kouanfack C., Laborde-Balen G., Boyer S., Aghokeng Fobang Avelin, Carrieri M. P., Kaze S., Dontsop M., Mben J. M., Koulla-Shiro S., Peytavin G., Spire B., Delaporte Eric, Laurent Christian. (2015). Gender differences in adherence and response to antiretroviral treatment in the stratall trial in rural district hospitals in Cameroon. Jaids.Journal of Acquired Immune Deficiency Syndromes, 69 (3), p. 355-364. ISSN 1525-4135.

Titre du document
Gender differences in adherence and response to antiretroviral treatment in the stratall trial in rural district hospitals in Cameroon
Année de publication
2015
Type de document
Article référencé dans le Web of Science WOS:000356714600015
Auteurs
Boullé Charlotte, Kouanfack C., Laborde-Balen G., Boyer S., Aghokeng Fobang Avelin, Carrieri M. P., Kaze S., Dontsop M., Mben J. M., Koulla-Shiro S., Peytavin G., Spire B., Delaporte Eric, Laurent Christian
Source
Jaids.Journal of Acquired Immune Deficiency Syndromes, 2015, 69 (3), p. 355-364 ISSN 1525-4135
Background: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.Methods: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.Results: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).Conclusions: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.
Plan de classement
Santé : généralités [050] ; Entomologie médicale / Parasitologie / Virologie [052]
Description Géographique
CAMEROUN
Localisation
Fonds IRD [F B010064751]
Identifiant IRD
fdi:010064751
Contact