High mortality rates in men initiated on anti-retroviral treatment in KwaZulu-Natal, South Africa

In attaining UNAIDS targets of 90-90-90 to achieve epidemic control, understanding who the current utilizers of HIV treatment services are will inform efforts aimed at reaching those not being reached. A retrospective chart review of CAPRISA AIDS Treatment Program (CAT) patients between 2004 and 201...

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Published inPloS one Vol. 12; no. 9; p. e0184124
Main Authors Naidoo, Kogieleum, Hassan-Moosa, Razia, Yende-Zuma, Nonhlanhla, Govender, Dhineshree, Padayatchi, Nesri, Dawood, Halima, Adams, Rochelle Nicola, Govender, Aveshen, Chinappa, Tilagavathy, Abdool-Karim, Salim, Abdool-Karim, Quarraisha
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 13.09.2017
Public Library of Science (PLoS)
Subjects
Acquired immune deficiency syndrome
Adult
AIDS
Anti-HIV Agents - therapeutic use
Anti-Retroviral Agents - therapeutic use
Antiretroviral drugs
Antiretroviral therapy
Biology and Life Sciences
Body mass
Body mass index
CD4 antigen
Epidemics
Epidemiology
Female
HIV
HIV Infections - drug therapy
HIV Infections - mortality
HIV-1
Human immunodeficiency virus
Humans
Male
Medicine and Health Sciences
Men
Mortality
Patients
People and Places
Public health
Retrospective Studies
Sex Factors
South Africa - epidemiology
Treatment Outcome
Tuberculosis
Young Adult
New York
United States > US
South Africa
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Summary:In attaining UNAIDS targets of 90-90-90 to achieve epidemic control, understanding who the current utilizers of HIV treatment services are will inform efforts aimed at reaching those not being reached. A retrospective chart review of CAPRISA AIDS Treatment Program (CAT) patients between 2004 and 2013 was undertaken. Of the 4043 HIV-infected patients initiated on ART, 2586 (64.0%) were women. At ART initiation, men, compared to women, had significantly lower median CD4+ cell counts (113 vs 131 cells/mm3, p <0.001), lower median body mass index (BMI) (21.0 vs 24.2 kg/m2, p<0.001), higher mean log viral load (5.0 vs 4.9 copies/ml, p<0.001) and were significantly older (median age: 35 vs. 32 years, p<0.001). Men had higher mortality rates compared to women, 6.7 per 100 person-years (p-y), (95% CI: 5.8-7.8) vs. 4.4 per 100 p-y, (95% CI: 3.8-5.0); mortality rate ratio: 1.54, (95% CI: 1.27-1.87), p <0.001. Age-standardised mortality rate was 7.9 per 100 p-y (95% CI: 4.1-11.7) for men and 5.7 per 100 p-y (95% CI: 2.7 to 8.6) for women (standardised mortality ratio: 1.38 (1.15 to 1.70)). Mean CD4+ cell count increases post-ART initiation were lower in men at all follow-up time points. Men presented later in the course of their HIV disease for ART initiation with more advanced disease and experienced a higher mortality rate compared to women.
Bibliography:Competing Interests: The authors have the following competing interests to declare: 1) Money to Institution for payment/support of work submitted: • PEPFAR • National Institute of Health/NAID • Howard Hughes Medical Institute • PHE 2) Board Membership: • Executive Director, Board of Control, Centre for the AIDS Program of Research in South Africa (CAPRISA) • Medscape Infectious Disease & HIV/AIDS Editorial Advisory Boards 3) Public access funding: Research Councils: Yes. 4) Grants: • Study: The CAPRISA Regional Center for Advanced Clinical Management. Duration of funding: 04/01/2014-03/31/2019. • Study: Addressing challenges in scaling up TB and HIV treatment integration in public health settings in SA. Duration of funding: 10/01/2014-12/31/2016. • Newton Fund (Naidoo K) South African Medical Research Council 01/01/2016-12/31/2018. Addressing challenges in scaling up TB and HIV treatment integration in public health settings in South Africa. Description: The major goal on this study is to develop, implement and evaluate an integrated TB-HIV primary care model of service delivery that can improve HIV and TB outcomes in co-infected patients. Role: Principal Investigator. • BR-C 13/0056 (Naidoo K) BroadReach/USAID 10/01/2014-12/31/2016. Addressing challenges in scaling up TB and HIV treatment integration in public health settings in SA. Description: The major goal on this study is to develop, implement and evaluate an integrated TB-HIV primary care model of service delivery that can improve HIV and TB outcomes in co-infected patients. Role: Principal Investigator • OPP1137034 (Hatherill M) UCT/Bill & Melinda Gates Foundation 10/05/2015 – 02/28/2019. A Clinical Trial of a Correlate of Risk Targeted Screen and Treat Strategy to Impact TB Control. Description: The major goal of this study is to control the global TB epidemic by testing a strategy to identify people with undiagnosed TB and people at high risk of developing TB disease using correlates of risk, in order to treat them before they transmit TB to others. Role: Subcontract Principal Investigator. • Extramural Unit (Abdool Karim SS). South African Medical Research Council 01/01/2016-12/31/2018. MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit. Description: The major goal on this MRC extramural unit is to undertake research to reduce morbidity and mortality from HIV-TB co-infection. Role: Co - Principal Investigator. • Medical Research Council of South Africa (MRC) SHIP Program (Scriba T) South African Medical Research Council 08/13/2014 – 07/31/2017. Systems immunology of ID93 vaccine-induced protection against recurrent TB disease. The aim of this consortium is to understand biomarkers of TB recurrence in multiple cohorts. Role: Co-Principle Investigator. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. There are no restrictions on sharing of data.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0184124