Impact of gender on response to highly active antiretroviral therapy in HIV-1 infected patients: a nationwide population-based cohort studyReportar como inadecuado




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BMC Infectious Diseases

, 12:293

HIV and co-infections

Abstract

BackgroundImpact of gender on time to initiation, response to and risk of modification of highly active antiretroviral therapy HAART in HIV-1 infected individuals is still controversial.

MethodsFrom a nationwide cohort of Danish HIV infected individuals we identified all heterosexually infected women N=587 and heterosexually infected men N=583 with no record of Hepatitis C infection diagnosed with HIV after 1 January 1997. Among these subjects, 473 women 81% and 435 men 75% initiated HAART from 1 January 1997 to 31 December 2009. We used Cox regression to calculate hazard ratio HR for time to initiation of HAART, Poisson regression to assess incidence rate ratios IRR of risk of treatment modification the first year, logistic regression to estimate differences in the proportion with an undetectable viral load, and linear regression to detect differences in CD4 count at year 1, 3 and 6 after start of HAART.

ResultsAt initiation of HAART, women were younger, predominantly of Black ethnicity and had a higher CD4 count adjusted p=0.026 and lower viral load adjusted p=0.0003. When repeating the analysis excluding pregnant women no difference was seen in CD4 counts adjusted p=0.21. We observed no delay in time to initiation of HAART in women compared to men HR 0.91, 95% CI 0.79-1.06. There were no gender differences in risk of treatment modification of the original HAART regimen during the first year of therapy for either toxicity IRR 0.97 95% CI 0.66-1.44 or other-unknown reasons IRR 1.18 95% CI 0.76-1.82. Finally, CD4 counts and the risk of having a detectable viral load at 1, 3 and 6 years did not differ between genders.

ConclusionsIn a setting with free access to healthcare and HAART, gender does neither affect time from eligibility to HAART, modification of therapy nor virological and immunological response to HAART. Differences observed between genders are mainly attributable to initiation of HAART in pregnant women.

KeywordsHIV Gender differences Modification HAART Viral suppression AbbreviationsHAARTHighly active antiretroviral therapy

ARTAntiretroviral therapy

ADIAIDS defining illness

DHCSDanish HIV Cohort Study

CRSThe Civil Registration System

CPRThe Danish Personal Identification number

HCVHepatitis C

HBVHepatitis B

NRTINucleoside reverse transcriptase inhibitor

NNRTINon-nucleoside reverse transcriptase inhibitors

PIProtease inhibitor

IRIncident rate

IRRIncident rate ratio

ORHazard ratio

OROdd ratio

IQRInterquartile range.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-12-293 contains supplementary material, which is available to authorized users.

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Autor: Kristina Thorsteinsson - Steen Ladelund - Søren Jensen-Fangel - Isik Somuncu Johansen - Terese L Katzenstein - Gitte Pede

Fuente: https://link.springer.com/







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