Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi

Solomon Chih Cheng Chen, Joseph Kwong Leung Yu, Anthony David Harries, Chin Nam Bong, Rose Kolola-Dzimadzi, Teck Siang Tok, Chwan Chuen King, Jung Der Wang

Research output: Contribution to journalArticle

67 Citations (Scopus)


Objective: To investigate the effect of gender on mortality of HIV-infected adults receiving antiretroviral therapy (ART) and its possible reasons. Methods: A retrospective study to review the records for outcomes of adult cases receiving ART at Mzuzu Central Hospital, Malawi, between July 2004 and December 2006. Results: Over the study period, 2838 adult AIDS patients received ART. Of these, 2029 (71.5%) were alive and still on ART, 376 (13.2%) were dead and 433 (15.3%) were lost to follow-up. Survival analysis with Kaplan-Meier estimator showed significantly higher survival rates among females than males in WHO stage 1, 2 and 3 (both P < 0.0001) and borderline in stage 4 (P = 0.076). The Cox model revealed a death hazard ratio (males vs. females) of 1.70 (95% confidence interval 1.35-2.15) after controlling for WHO clinical stages, body mass index and age. More men than women were lost to follow-up in all occupations except health workers. Conclusions: The most important reasons for a higher mortality in male patients starting ART may relate to their seeking medical care at a more advanced stage of immunodeficiency and poorer compliance with therapy. The issue needs to be addressed in scaling up ART programmes in Africa.

Original languageEnglish
Pages (from-to)513-519
Number of pages7
JournalTropical Medicine and International Health
Issue number4
Publication statusPublished - 2008 Apr 1

All Science Journal Classification (ASJC) codes

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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