Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda

dc.contributor.authorMills, Edwarden_ZA
dc.contributor.authorBakanda, Celestinen_ZA
dc.contributor.authorBirungi, Josephineen_ZA
dc.contributor.authorChan, Keithen_ZA
dc.contributor.authorHogg, Roberten_ZA
dc.contributor.authorFord, Nathanen_ZA
dc.contributor.authorNachega, Jeanen_ZA
dc.contributor.authorCooper, Curtisen_ZA
dc.date.accessioned2015-10-30T09:30:55Z
dc.date.available2015-10-30T09:30:55Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND:Because men in Africa are less likely to access HIV/AIDS care than women, we aimed to determine if men have differing outcomes from women across a nationally representative sample of adult patients receiving combination antiretroviral therapy in Uganda. METHODS: We estimated survival distributions for adult male and female patients using Kaplan-Meier, and constructed multivariable regressions to model associations of baseline variables with mortality. We assessed person-years of life lost up to age 55 by sex. To minimize the impact of patient attrition, we assumed a weighted 30% mortality rate among those lost to follow up. RESULTS: We included data from 22,315 adults receiving antiretroviral therapy. At baseline, men tended to be older, had lower CD4 baseline values, more advanced disease, had pulmonary tuberculosis and had received less treatment follow up (all at p < 0.001). Loss to follow up differed between men and women (7.5 versus 5.9%, p < 0.001). Over the period of study, men had a significantly increased risk of death compared with female patients (adjusted hazard ratio 1.43, 95% CI 1.31-1.57, p < 0.001). The crude mortality rate for males differed importantly from females (43.9, 95% CI 40.7-47.0/1000 person-years versus 26.9, 95% CI 25.4-28.5/1000 person years, p < 0.001). The probability of survival was 91.2% among males and 94.1% among females at 12 months. Person-years of life lost was lower for females than males (689.7 versus 995.9 per 1000 person-years, respectively). CONCLUSIONS: In order to maximize the benefits of antiretroviral therapy, treatment programmes need to be gender sensitive to the specific needs of both women and men. Particular efforts are needed to enroll men earlier into care.en_ZA
dc.identifier.apacitationMills, E., Bakanda, C., Birungi, J., Chan, K., Hogg, R., Ford, N., ... Cooper, C. (2011). Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda. <i>Journal of the International AIDS Society</i>, http://hdl.handle.net/11427/14517en_ZA
dc.identifier.chicagocitationMills, Edward, Celestin Bakanda, Josephine Birungi, Keith Chan, Robert Hogg, Nathan Ford, Jean Nachega, and Curtis Cooper "Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda." <i>Journal of the International AIDS Society</i> (2011) http://hdl.handle.net/11427/14517en_ZA
dc.identifier.citationMills, E. J., Bakanda, C., Birungi, J., Chan, K., Hogg, R. S., Ford, N., ... & Cooper, C. L. (2011). Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda. Journal of the International AIDS Society, 14(1), 52.en_ZA
dc.identifier.ris TY - Journal Article AU - Mills, Edward AU - Bakanda, Celestin AU - Birungi, Josephine AU - Chan, Keith AU - Hogg, Robert AU - Ford, Nathan AU - Nachega, Jean AU - Cooper, Curtis AB - BACKGROUND:Because men in Africa are less likely to access HIV/AIDS care than women, we aimed to determine if men have differing outcomes from women across a nationally representative sample of adult patients receiving combination antiretroviral therapy in Uganda. METHODS: We estimated survival distributions for adult male and female patients using Kaplan-Meier, and constructed multivariable regressions to model associations of baseline variables with mortality. We assessed person-years of life lost up to age 55 by sex. To minimize the impact of patient attrition, we assumed a weighted 30% mortality rate among those lost to follow up. RESULTS: We included data from 22,315 adults receiving antiretroviral therapy. At baseline, men tended to be older, had lower CD4 baseline values, more advanced disease, had pulmonary tuberculosis and had received less treatment follow up (all at p < 0.001). Loss to follow up differed between men and women (7.5 versus 5.9%, p < 0.001). Over the period of study, men had a significantly increased risk of death compared with female patients (adjusted hazard ratio 1.43, 95% CI 1.31-1.57, p < 0.001). The crude mortality rate for males differed importantly from females (43.9, 95% CI 40.7-47.0/1000 person-years versus 26.9, 95% CI 25.4-28.5/1000 person years, p < 0.001). The probability of survival was 91.2% among males and 94.1% among females at 12 months. Person-years of life lost was lower for females than males (689.7 versus 995.9 per 1000 person-years, respectively). CONCLUSIONS: In order to maximize the benefits of antiretroviral therapy, treatment programmes need to be gender sensitive to the specific needs of both women and men. Particular efforts are needed to enroll men earlier into care. DA - 2011 DB - OpenUCT DO - 10.1186/1758-2652-14-52 DP - University of Cape Town J1 - Journal of the International AIDS Society LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda TI - Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda UR - http://hdl.handle.net/11427/14517 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14517
dc.identifier.urihttp://dx.doi.org/10.1186/1758-2652-14-52
dc.identifier.vancouvercitationMills E, Bakanda C, Birungi J, Chan K, Hogg R, Ford N, et al. Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda. Journal of the International AIDS Society. 2011; http://hdl.handle.net/11427/14517.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2011 Mills et al; licensee BioMed Central Ltden_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceJournal of the International AIDS Societyen_ZA
dc.source.urihttp://www.biomedcentral.com/1758-2652/en_ZA
dc.subject.otherAntiretroviral Therapyen_ZA
dc.subject.otherHIV Infectionsen_ZA
dc.subject.otherUgandaen_ZA
dc.titleMale gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Ugandaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
Files
Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Mills_Male_gender_predicts_mortality_2011.pdf
Size:
533.28 KB
Format:
Adobe Portable Document Format
Description:
Collections