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Original article

Outcomes in the first year after initiation of first-line HAART among heterosexual men and women in the UK CHIC Study

Tristan J Barber, Anna Maria Geretti, Jane Anderson, Achim Schwenk, Andrew N Phillips, Loveleen Bansi, Richard Gilson, Teresa Hill, John Walsh, Martin Fisher, Margaret Johnson, Frank Post, Philippa Easterbrook, Brian Gazzard, Adrian Palfreeman, Chloe Orkin, Clifford Leen, Mark Gompels, David Dunn, Valerie Delpech, Deenan Pillay, Caroline A Sabin, UK CHIC Study Steering Committee

Corresponding author name: Tristan J Barber
Corresponding author e-mail: t.barber@nhs.net

Citation: Antiviral Therapy 2011; 16:805-814
doi: 10.3851/IMP1818

Date accepted: 03 January 2011
Date published online: 10 June 2011

Abstract

Background: We analysed the influence of gender on use and outcomes of first-line HAART in a UK cohort.

Methods: Analyses included heterosexuals starting HAART from 1998–2007 with pre-treatment CD4+ T-cell count <350 cells/mm3 and viral load (VL)>500 copies/ml. Virological suppression (<50 copies/ml), virological rebound (>500 copies/ml), CD4+ T-cell counts at 6 and 12 months, clinical events and treatment discontinuation/switch in the first year of HAART were compared using linear, logistic and Cox regression.

Results: Compared with women (n=2,179), men (n=1,487) were older and had lower CD4+ T-cell count and higher VL at start of HAART. Median follow-up was 3.8 years (IQR 2.0–6.2). At 6 and 12 months, 72.7% and 75.3% had VL≤50 copies/ml, with no large differences between genders at either time after adjustment for confounders (6 months, OR 0.92 [95% CI 0.76–1.13]; 12 months, OR 1.06 [95% CI 0.85–1.31]). Overall, 79.4% patients achieved virological suppression and 19.2% experienced virological rebound, without gender differences, although men had an increased risk of rebound after excluding pregnant women (adjusted relative hazard [RH] 1.33 [95% CI 1.04–1.71]). Mean CD4+ T-cell count increases at 6 and 12 months were, respectively, 112 and 156 cells/mm3 overall, with mean differences between men and women of -14.6 cells/mm3 (95% CI -24.6–-4.5) and -12.1 cells/mm3 (95% CI -24.4–0.2) at 6 and 12 months, respectively. Clinical progression was similar in men and women, but men were less likely to experience treatment discontinuation/switch (adjusted RH 0.72 [95% CI 0.63–0.83]).

Conclusions: Despite higher discontinuation rates among women, men had an increased risk of virological rebound and slightly poorer CD4+ T-cell count responses. Identifying the reasons underlying treatment discontinuation/switch may help optimize treatment strategies for both genders.

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