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Men have lower CD4 counts, higher attrition rate in Africa
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CDC researchers found lower median CD4 counts in HIV-infected men compared with HIV-infected women in several African countries, according to MMWR. Men also were more likely to have more advanced HIV disease at enrollment and a higher risk for attrition during antiretroviral therapy.
"Evaluation of differences between [HIV]-infected men and women in [ART] enrollment characteristics and outcomes might identify opportunities to improve ART program patient outcomes and prevention impact," the researchers wrote.
Retrospective cohort studies conducted between September 2008 and February 2012 were used to estimate attrition rates among ART enrollees in six African countries, including Côte d'Ivoire in western Africa; Swaziland, Mozambique and Zambia in southern Africa; and Uganda and Tanzania in eastern Africa. Sample sizes in each country ranged from 1,457 to 3,682, with women comprising 61% to 67% of each sample.
Results indicated that the median CD4 count was significantly lower in men vs. women in Côte d'Ivoire (119 cells/mcL vs. 155 cells/mcL), Swaziland (121 cells/mcL vs. 161 cells/mcL) and Uganda (128 cells/mcL vs. 144 cells/mcL). The median CD4 count also was lower for men than it was for women in Mozambique, Zambia and Tanzania, but these differences were not statistically significant, the researchers said.
Men also were more likely than women to have WHO stage IV HIV disease at enrollment in all six countries: Côte d'Ivoire (26% vs. 21%), Swaziland (18% vs. 10%), Mozambique (20% vs. 13%), Zambia (11% vs. 9%), Uganda (16% vs. 10%) and Tanzania (30% vs. 27%).
In all countries, attrition during the first 4.5 years of ART was lower for women than men, particularly in countries in western and southern Africa, where women had 15% to 26% lower rates of attrition in analyses that were restricted to cases with complete data for sex, age, CD4 count, WHO HIV disease stage and ART regimen.
"This finding suggests that unidentified factors are contributing to this higher attrition risk in these countries," the researchers wrote. "In eastern Africa, risk for attrition did not differ significantly between men and women."
Disclosure: The researchers report no relevant financial disclosures.
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