Gender Differences In Outcomes Of Antiretroviral Treatment Among Hiv-infected Individuals In China

BackgroundThis study aims to explore gender differences in outcomes of treatment,including virological suppression,retention in treatment,and mortality,in people with HIV receiving combination antiretroviral therapy in China.To provide evidence for better understanding the role of gender in response to antiretroviral treatment in a resource-limited setting and further identifying the reasons.MethodsWe did a nationwide retrospective observational cohort study with data from the China National Free Antiretroviral Treatment Program(NFATP).Antiretroviral-naive patients older than 18 years initiating standard antiretroviral therapy between January 1,2010 and December 31,2011 were included in our study and followed for four years,the end time of the study was Dec 31,2015.We used logistic regression models for overall and stratified analyses,to estimate the impact of gender on virological suppression and retention in treatment,and Kaplan-Meier analysis and Cox proportional hazard models to evaluate gender difference in mortality.Covariables included age,body mass index,region,marital status,route of transmission,baseline CD4 count,initial treatment regimen,and time interval between diagnosis and initiation of treatment.All analysis were performed with SAS statistical software version 9.3(SAS Institute Inc.,Cary,NC,USA).ResultsTotally,68646 individuals(46083(67.1%)men and 22563(32.9%)women)with HIV met eligibility criteria.We found that women were more likely to achieve virological suppression than men both at 12 months(adjusted odds ratio(aOR):1.13,95%CI:1.06-1.21)and 48 months(aOR:1.10,95%CI:1.01-1.20)after initiating antiretroviral treatment.Women were also significantly more likely to retain in treatment at 12 months(aOR:1.15,95%CI:1.08-1.23)and 48 months(aOR:1.22,95%CI:1.15-1.29)after initiating antiretroviral treatment.All-cause mortality was 3.45 deaths/100PY,lower in women than in men(2.34 vs.4.03 deaths/100PY,adjusted hazard ratio 0.71,95%CI 0.66-0.76).Women had a significantly higher virological suppression rate than men in patients who initiated treatment between 18 and 44 years old,patients from country,patients who infected HIV through blood transfusion or injection drug use,patients whose baseline CD4 cell count was in 200-349 cells/μL and patients who initiated treatment more than 3 months after diagnosis.ConclusionOur study implies that in China,women are more likely to achieve virological suppression,retain in treatment and have a significantly lower risk of death than men.But the gender difference on retention might be largely ascribed to the gender disparity in mortality.Our results are valuable in understanding the role of gender in response to ART in a resource-limited setting.Future studies could focus on the relationship between gender and adherence to treatment,and take both biological and socio-behavioral factors into analysis to clarify the influence factors.