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Open Access Research article

Women experience a better long-term immune recovery and a better survival on HAART in Lao People’s Democratic Republic

Mathieu Bastard1*, Khamphang Soulinphumy2, Prasith Phimmasone34, Ahmed Hassani Saadani5, Laura Ciaffi5, Arlette Communier5, Chansy Phimphachanh6, René Ecochard789 and Jean-François Etard110

Author Affiliations

1 Epicentre, Paris, France

2 Ministry of Health/HIV Unit, Savannakhet Hospital, Savannakhet, Lao PDR

3 Mahosot Hospital, Vientiane, Lao PDR

4 Institut de la Francophonie pour la Médecine Tropicale, Vientiane, Lao PDR

5 Médecins Sans Frontières, Geneva, Switzerland

6 Ministry of Health – Centre for HIV, AIDS and STIs, Vientiane, Lao PDR

7 Hospices Civils de Lyon, Service de Biostatistique, Lyon, F-69003, France

8 Université Lyon I, Villeurbanne, F-69100, France

9 CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, Pierre-Bénite, F-69310, France

10 UMI 233 TransVIHMI, Institut de Recherche pour le Développement, Université Montpellier 1, Montpellier, France

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BMC Infectious Diseases 2013, 13:27  doi:10.1186/1471-2334-13-27

Published: 22 January 2013

Abstract

Background

In April 2003, Médecins Sans Frontières launched an HIV/AIDS programme to provide free HAART to HIV-infected patients in Laos. Although HIV prevalence is estimated as low in this country, it has been increasing in the last years. This work reports the first results of an observational cohort study and it aims to identify the principal determinants of the CD4 cells evolution and to assess mortality among patients on HAART.

Methods

We performed a retrospective database analysis on patients initiated on HAART between 2003 and 2009 (CD4<200cells/μL or WHO stage 4). We excluded from the analysis patients who were less than 16 years old and pregnant women. To explore the determinants of the CD4 reconstitution, a linear mixed model was adjusted. To identify typical trajectories of the CD4 cells, a latent trajectory analysis was carried out. Finally, a Cox proportional-hazards model was used to reveal predictors of mortality on HAART including appointment delay greater than 1 day.

Results

A total of 1365 patients entered the programme and 913 (66.9%) received an HAART with a median CD4 of 49 cells/μL [IQR 15–148]. High baseline CD4 cell count and female gender were associated with a higher CD4 level over time. In addition, this gender difference increased over time. Two typical latent CD4 trajectories were revealed showing that 31% of women against 22% of men followed a high CD4 trajectory. In the long-term, women were more likely to attend appointments without delay. Mortality reached 6.2% (95% CI 4.8-8.0%) at 4 months and 9.1% (95% CI 7.3-11.3%) at 1 year. Female gender (HR=0.17, 95% CI 0.07-0.44) and high CD4 trajectory (HR=0.19, 95% CI 0.08-0.47) were independently associated with a lower death rate.

Conclusions

Patients who initiated HAART were severely immunocompromised yielding to a high early mortality. In the long-term on HAART, women achieved a better CD4 cells reconstitution than men and were less likely to die. This study highlights important differences between men and women regarding response to HAART and medical care, and questions men’s compliance to treatment.