Male sex and the risk of mortality among individuals enrolled in antiretroviral therapy programs in Africa: A systematic review and meta-analysis

Eric Druyts, Mark Dybul, Steve Kanters, Jean Nachega, Josephine Birungi, Nathan Ford, Kristian Thorlund, Joel Negin, Richard Lester, Sanni Yaya, Edward J. Mills

Research output: Contribution to journalArticle

Abstract

BACKGROUND: HIV/AIDS has historically had a sex and gender-focused approach to prevention and care. Some evidence suggests that HIV-positive men have worse treatment outcomes than their women counterparts in Africa. METHODS: We conducted a systematic review and meta-analysis of the effect of sex on the risk of death among participants enrolled in antiretroviral therapy (ART) programs in Africa since the rapid scale-up of ART. We included all cohort studies evaluating the effect of sex (male, female) on the risk of death among participants enrolled in regional and national ART programs in Africa. We identified these studies by searching MedLine, EMBASE, and Cochrane CENTRAL. We used a DerSimonian-Laird random-effects method to pool the proportions of men receiving ART and the hazard ratios for death by sex. RESULTS: Twenty-three cohort studies, including 216008 participants (79892 men) contributed to our analysis. The pooled proportion of men receiving ART was 35% [95% confidence interval (CI): 33-38%]. The pooled hazard ratio estimate indicated a significant increase in the risk of death for men when compared to women [hazard ratio: 1.37 (95% CI: 1.28-1.47)]. This was consistent across sensitivity analyses. INTERPRETATION: The proportion of men enrolled in ART programs in Africa is lower than women. Additionally, there is an increased risk of death for men enrolled in ART programs. Solutions that aid in reducing these sex inequities are needed.

Original languageEnglish (US)
Pages (from-to)417-425
Number of pages9
JournalAIDS
Volume27
Issue number3
DOIs
StatePublished - Jan 28 2013

Keywords

  • Africa
  • HIV
  • antiretroviral therapy
  • men
  • meta-analysis
  • mortality

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Druyts, E., Dybul, M., Kanters, S., Nachega, J., Birungi, J., Ford, N., Thorlund, K., Negin, J., Lester, R., Yaya, S., & Mills, E. J. (2013). Male sex and the risk of mortality among individuals enrolled in antiretroviral therapy programs in Africa: A systematic review and meta-analysis. AIDS, 27(3), 417-425. https://doi.org/10.1097/QAD.0b013e328359b89b