Male Gender Predicts Mortality in a Large Cohort of Patients Receiving Antiretroviral Therapy in Uganda

Background:Because men in Africa are less likely to access HIV/AIDS care than women, we aimed to determine ifmen have differing outcomes from women across a nationally representative sample of adult patients receivingcombination antiretroviral therapy in Uganda.Methods:We estimated survival distributions for adult male and female patients using Kaplan-Meier, andconstructed multivariable regressions to model associations of baseline variables with mortality. We assessedperson-years of life lost up to age 55 by sex. To minimize the impact of patient attrition, we assumed a weighted30% mortality rate among those lost to follow up.Results:We included data from 22,315 adults receiving antiretroviral therapy. At baseline, men tended to be older,had lower CD4 baseline values, more advanced disease, had pulmonary tuberculosis and had received lesstreatment follow up (all at p < 0.001). Loss to follow up differed between men and women (7.5 versus 5.9%, p <0.001). Over the period of study, men had a significantly increased risk of death compared with female patients(adjusted hazard ratio 1.43, 95% CI 1.31-1.57, p < 0.001). The crude mortality rate for males differed importantlyfrom females (43.9, 95% CI 40.7-47.0/1000 person-years versus 26.9, 95% CI 25.4-28.5/1000 person years, p < 0.001).The probability of survival was 91.2% among males and 94.1% among females at 12 months. Person-years of lifelost was lower for females than males (689.7 versus 995.9 per 1000 person-years, respectively).Conclusions:In order to maximize the benefits of antiretroviral therapy, treatment programmes need to begender sensitive to the specific needs of both women and men. Particular efforts are needed to enroll men earlierinto care.