Gender differences in a large-scale HAART program in western Kenya
Background: Several studies have found differences in rates of HIV disease progression and responses to antiretroviral therapy between HIV-infected women and men. However, most of these studies are from developed countries and there is limited data from large-scale HIV treatment programs in resource-constrained settings. This study aims to describe gender differences in registration, treatment initiation and treatment outcomes from a HIV treatment program run by Médecins Sans Frontières in Busia, Kenya.
Methods: Between June 2003 and July 2005, 4,650 individuals were registered in the program and 1288 adult patients were started on ART. More than 90% were treated with a standard combination of lamivudine, stavudine and nevirapine. Routine measures included CD4 cell count (x 106 cells/l) and clinical staging, but not viral load testing. All treatment was provided free of charge.
Results: Of the 1288 patients initiating HAART, 883 (69%) were women, reflecting the 68% women among the total registered. Women on HAART were younger (median age 35 compared to 41 among men) and had higher baseline CD4 levels than men (median 116 and 88 respectively). By December 2005 (median 11 months follow-up), 14% of men and 8% of women had died (p<0.05). Additionally 7% of men and women were lost to follow-up. Using survival analysis, by 12 months, 78% of men and 83% of women remained alive and on treatment. Among those who remained on treatment, women were significantly less likely to die than men. This difference remained in a Cox regression analysis that included baseline CD4 count. Women also demonstrated greater CD4 responses at 6 and 12 months on ART than men.
Conclusions: These results suggest that, in our setting, women respond better to antiretroviral treatment and that this is reflected in better survival. Whether this is due to biological or social and behavioural factors warrants further investigation.
AIDS 2006 - XVI International AIDS Conference
"E.CarillodeCasas, et al.
Gender differences in a large-scale HAART program in western Kenya.
Oral abstract session:
AIDS 2006 - XVI International AIDS Conference: