AEGiS-13IAC: The effect of gender on HIV progression and mortality in a cohort of Zambian adults, followed for up to 7 years.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

The effect of gender on HIV progression and mortality in a cohort of Zambian adults, followed for up to 7 years.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB401)

Quigley M, Mwinga A, Hosp M, Lisse I, Fuchs D, Porter J, Godfrey-Faussett P
M. Quigley, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, Tel.: +44 0171 927 2165, Fax: +44 0171 436 4230, E-mail: maria.quigley@lshtm.ac.uk

OBJECTIVE: To compare HIV progression and mortality rates in men and women in a cohort of HIV infected Zambian adults.

METHODS: Between Aug 1992 and June 1994, 1053 HIV infected adults were enrolled into a randomised trial of preventive therapy for TB. Subjects were seen every 3 months and followed until death, or censored in Sept 1999. CD4%, neopterin, absolute lymphocyte count, and haemoglobin were measured from enrolment (absolute CD4 counts from 12 months after enrolment). Progression markers measured 1-6 months after enrolment (12-18 months after enrolment for CD4 count) are referred to as baseline values.

RESULTS: 79 subjects had no follow-up leaving 974 subjects (43% female) for the analysis. By Sept 1999, there were 281 deaths in 3005 person-years. Mortality was associated with all baseline progression markers (p>0.001), age and marital status, but not with education, crowding, or TB preventive therapy. Women had a shorter survival time than men (40% versus 33% died within 5 years of enrolment), despite similar baseline CD4 (median = 234 in men & 237 in women). Mortality was higher in women (10.1 per 100 person-years) than in men (8.8), but not significantly so (rate ratio 'RR' adjusted for age and marital status = 1.17, 95% CI:0.91-1.51). In those with baseline CD4> = 200 women had a higher mortality rate than men (RR = 4.23, 95% CI:1.38-12.97), whereas in those with baseline CD4>200 the mortality rate was lower than in men (RR = 0.78, 95% CI:0.42-1.47). Decline in CD4 count and CD4% and rise in neopterin were more rapid in women than in men although this effect was only significant for CD4 count (median annual decline = 27.1 in men & 36.0 in women, p = 0.017).

CONCLUSIONS: These results suggest that HIV progression in this cohort is faster in women than in men. Whether this effect is due to biological differences or to socio-cultural effects, interventions to reduce morbidity and mortality should be tailored to be gender sensitive.

Keywords: AEGIS, HIV Infections, CD4 Lymphocyte Count, HIV Seropositivity, Morbidity, Survival Rate, Sex, Adult, Human, Male, Female, mortality, Epidemiology
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