Are there differences in disease progression and mortality among male and female HIV patients on antiretroviral therapy? A meta-analysis of observational cohorts

ABSTRACT

Studies examining the sex differences in morbidity and mortality among HIV/AIDS patients have yielded inconsistent results. We conducted a meta-analysis of sex differences in disease progression and mortality among HIV/AIDS patients. Medical literature databases from inception to August 2014 were searched for published observational studies assessing sex differences in immunologic and virologic response, disease progression and mortality among HIV-infected patients. Random effects meta-analyses of 115 eligible studies were conducted to obtain pooled estimates of outcomes and heterogeneity was explored in sub-group analyses. Pooled estimates showed an increased risk of progression to AIDS (relative risk [RR]=1.11,95% CI=1.02–1.21) and all-cause mortality (RR=1.23, 95% CI=1.17–1.29) among males compared to females. All-cause mortality differed by sex only in low and middle income countries. The risk of AIDS-related mortality (RR=1.03, 95% CI=0.82–1.30), immunologic failure (RR=1.19,95% CI: 0.97–1.47), virologic suppression (RR=0.98, 95% CI=0.84–1.14), virologic failure (RR=1.26, 95% CI=0.99–1.61) and the change in CD4 cell count (Weighted mean difference [WMD] = −5.15, 95% CI= −13.57 to 3.28) did not differ by sex. These findings were modified by disease severity, adherence and use of highly active antiretroviral therapy. We conclude that HIV-related disease progression and survival outcomes are poorer in males.

KEYWORDS:

• HIV/AIDS
• gender
• mortality
• CD4 cell count
• viral load
• antiretroviral therapy

Acknowledgements

Authorship: The authors' responsibilities were as follows – AIA-1 and MOO-2: designed the research; AIA, AIS, AAS, MOO-1, TAO, AIA-2, KAI, and MOO-2: conducted the research; AIA-1 and AAS: analyzed data; AIA-1, AIS, MOO-1, and MOO-2: wrote the manuscript; AIA: had the primary responsibility for the final content of the manuscript; and all authors: contributed to and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

A.I. Abioye http://orcid.org/0000-0002-6632-613X

Additional information

Funding

This meta-analysis received no specific grant from any funding agency in the public, commercial, or nonprofit sectors.