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Ten-year attrition and antiretroviral therapy response among HIV-positive adults: a sex-based cohort analysis from eight West African countries

dc.rights.licenseopenen_US
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorTIENDREBEOGO, Kiswend-Sida Thierry
dc.contributor.authorMESSOU, Eugene
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorARIKAWA, Shino
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorEKOUEVI, Didier Koumavi
dc.contributor.authorTANON, Aristophane
dc.contributor.authorKWAGHE, Vivian
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorBALESTRE, Eric
dc.contributor.authorZANNOU, Marcel Djimon
dc.contributor.authorPODA, Armel
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorDABIS, Francois
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorJAQUET, Antoine
dc.contributor.authorMINGA, Albert
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorBECQUET, Renaud
dc.contributor.authorIE, D. E. A. West Africa Collaboration
dc.date.accessioned2021-07-09T09:27:06Z
dc.date.available2021-07-09T09:27:06Z
dc.date.issued2021-05
dc.identifier.issn1758-2652en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/106488
dc.description.abstractEnINTRODUCTION: Sex differences have already been reported in sub-Saharan Africa for attrition and immunological response after antiretroviral therapy (ART) initiation, but follow-up was usually limited to the first two to three years after ART initiation. We evaluated sex differences on the same outcomes in the 10 years following ART initiation in West African adults. METHODS: We used cohort data of patients included in the IeDEA West Africa collaboration, who initiated ART between 2002 and 2014. We modelled no-follow-up and 10-year attrition risks, and immunological response by sex using logistic regression analysis, survival analysis with random effect and linear mixed models respectively. RESULTS: A total of 71,283 patients (65.8% women) contributed to 310,007 person-years of follow-up in 16 clinics in eight West African countries. The cumulative attrition incidence at 10-year after ART initiation reached 75% and 68% for men and women respectively. Being male was associated with an increased risk of no follow-up after starting ART (5.1% vs. 4.0%, adjusted Odds Ratio: 1.25 [95% CI: 1.15 to 1.35]) and of 10-year attrition throughout the 10-year period following ART initiation: adjusted Hazard Ratios were 1.22 [95% CI: 1.17 to 1.27], 1.08 [95% CI: 1.04 to 1.12] and 1.04 [95% CI: 1.01 to 1.08] during year 1, years 2 to 4 and 5 to 10 respectively. A better immunological response was achieved by women than men: monthly CD4 gain was 30.2 and 28.3 cells/mL in the first four months and 2.6 and 1.9 cells/μL thereafter. Ultimately, women reached the average threshold of 500 CD4 cells/μL in their sixth year of follow-up, whereas men failed to reach it even at the end of the 10-year follow-up period. The proportion of patients reaching the threshold was much higher in women than in men after 10 years since ART initiation (65% vs. 44%). CONCLUSIONS: In West Africa, attrition is unacceptably high in both sexes. Men are more vulnerable than women on both attrition and immunological response to ART in the 10 years following ART initiation. Innovative tracing strategies that are sex-adapted are needed for patients in care to monitor attrition, detect early high-risk groups so that they can stay in care with a durably controlled infection.
dc.language.isoENen_US
dc.rightsAttribution 3.0 United States*
dc.rights.urihttp://creativecommons.org/licenses/by/3.0/us/*
dc.subject.enHIV
dc.subject.enAntiretroviral therapy
dc.subject.enSex
dc.subject.enAttrition
dc.subject.enImmunological response
dc.subject.enWest Africa
dc.title.enTen-year attrition and antiretroviral therapy response among HIV-positive adults: a sex-based cohort analysis from eight West African countries
dc.typeArticle de revueen_US
dc.identifier.doi10.1002/jia2.25723en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed34021714en_US
bordeaux.journalJournal of the International AIDS Societyen_US
bordeaux.pagee25723en_US
bordeaux.volume24en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - UMR 1219en_US
bordeaux.issue5en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionINSERMen_US
bordeaux.teamIDLICen_US
bordeaux.teamIeDEAen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
bordeaux.identifier.funderIDEunice Kennedy Shriver National Institute of Child Health and Human Developmenten_US
bordeaux.identifier.funderIDNational Cancer Instituteen_US
bordeaux.identifier.funderIDAgence Nationale de Recherches sur le Sida et les Hépatites Viralesen_US
hal.identifierhal-03282511
hal.version1
hal.date.transferred2021-07-09T09:27:12Z
hal.exporttrue
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