Male sex and the risk of mortality among individuals enrolled in antiretroviral therapy programs in Africa: a systematic review and meta-analysis
Male sex and the risk of mortality among individuals enrolled in antiretroviral therapy programs in Africa: a systematic review and meta-analysis
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DOI：
10.1097/qad.0b013e328359b89b
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发表时间：
2013-01-28
期刊：
影响因子：
3.8
通讯作者：
Mills, Edward J.
中科院分区：
文献类型：
--
作者：
Druyts, Eric;Dybul, Mark;Mills, Edward J.
背景：艾滋病毒/艾滋病的预防和护理历来采取以性和性别为重点的办法。一些证据表明，在非洲，艾滋病毒阳性男性的治疗结果比女性更差。我们对自非洲抗逆转录病毒治疗（ART）迅速扩大以来，参加ART项目的参与者中性别对死亡风险的影响进行了系统回顾和荟萃分析。（男性，女性）对非洲区域和国家ART计划参与者的死亡风险进行了评估。我们通过检索MedLine、EMBASE和科克伦CENTRAL确定了这些研究。我们使用了DerSimonian-Laird随机效应的方法来汇总接受ART的男性比例和按性别划分的死亡风险比。结果：23项队列研究，包括216008名参与者（79892名男性），有助于我们的分析。接受抗逆转录病毒治疗的男性比例为35% [95%置信区间（CI）：33-38%]。汇总风险比估计值表明，与女性相比，男性的死亡风险显著增加[风险比：1.37（95% CI：1.28-1.47）]。这在敏感性分析中是一致的。解释：在非洲参加ART项目的男性比例低于女性。此外，参加抗逆转录病毒治疗方案的男性死亡风险增加。需要采取有助于减少这些性别不平等的解决办法。(C)2013年威科医疗|Lippincott威廉姆斯&威尔金斯艾滋病2013，27：417-425
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 216 008 participants (79 892 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. (C) 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2013, 27:417-425